Provider Demographics
NPI:1982755302
Name:SIMARI, RUDOLPH J JR
Entity Type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:J
Last Name:SIMARI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SECOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:CT
Mailing Address - Zip Code:06752-1031
Mailing Address - Country:US
Mailing Address - Phone:203-740-1700
Mailing Address - Fax:860-354-2969
Practice Address - Street 1:250 SECOND HILL RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:CT
Practice Address - Zip Code:06752-1031
Practice Address - Country:US
Practice Address - Phone:203-740-1700
Practice Address - Fax:860-354-2969
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000513101YA0400X
CT000007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP354065OtherOXFORD
CT258639OtherMHN
CT240000007CT02OtherANTHEM B
CT20326OtherCIGNA
CT240000007CT07OtherLPC T
CT240000007CT06OtherLPC W
CT466903OtherVALUEOPTIONS