MEDICARE: CAROL SIMONE

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	120898	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120898	OTHER	MA	BOARD OF REGISTRATION OF SOCIAL WORKERS

General Provider Information

NPI Number	:	1689152076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SIMONE

Provider Business Mailing Address
First Line	:	89 WASHINGTON AVE
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-2716
Country	:	US
Telephone Number	:	617-519-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 MOUNT AUBURN ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-5525
Country	:	US
Telephone Number	:	617-876-0369
Fax Number	:	617-876-6432

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

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/30/2018

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Directions to “ CAROL SIMONE ” Practice Location

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