MEDICARE: NANCY SIMONS LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5115	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1034520	OTHER	MA	BEACON HEALTH
2	55344	OTHER	MA	CIGNA
3	42035	OTHER	MA	TUFTS
4	32190	OTHER	MA	HEALTH NEW ENGLAND
5	LM0874	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1427103928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY SIMONS LMHC

Provider Business Mailing Address
First Line	:	54 SHUTESBURY RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9701
Country	:	US
Telephone Number	:	413-549-4854
Fax Number	:	413-549-4854

Provider Business Practice Location Address
First Line	:	54 SHUTESBURY RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9701
Country	:	US
Telephone Number	:	413-549-4854
Fax Number	:	413-549-4854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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