Healthcare Provider Details

I. General information

NPI: 1659819043
Provider Name (Legal Business Name): JOSHUA SIMEONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 NORMAL ST
SAN DIEGO CA
92103-3420
US

IV. Provider business mailing address

6 SOUTHSIDE RD
DANVERS MA
01923-1409
US

V. Phone/Fax

Practice location:
  • Phone: 978-270-8592
  • Fax:
Mailing address:
  • Phone: 978-626-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36783
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: