MEDICARE: MISS EMILY VANESSA SIMON

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100001899333	OTHER	MA	MASS HEALTH, BMC

General Provider Information

NPI Number	:	1679975031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMILY VANESSA SIMON

Provider Business Mailing Address
First Line	:	13 BEACON HILL AVE
Second Line	:	APT 2
City	:	LYNN
State	:	MA
Zip	:	01902-3702
Country	:	US
Telephone Number	:	781-913-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 BEACON HILL AVE
Second Line	:	APT 2
City	:	LYNN
State	:	MA
Zip	:	01902-3702
Country	:	US
Telephone Number	:	781-913-2121
Fax Number	:

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

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/17/2014

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Directions to “ MISS EMILY VANESSA SIMON ” Practice Location

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