MEDICARE: MRS. MARION MERRICK SIMONEAU LICSW

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	104100000X	Social Worker	116558	MA
2	1041C0700X	Clinical Social Worker	116558	MA

General Provider Information

NPI Number	:	1518308766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARION MERRICK SIMONEAU LICSW

Provider Business Mailing Address
First Line	:	251 HEATH ST
Second Line	:	UNIT 211
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-1171
Country	:	US
Telephone Number	:	978-430-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 HEATH ST
Second Line	:	UNIT 211
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-1171
Country	:	US
Telephone Number	:	978-430-2405
Fax Number	:

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

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	04/29/2014

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