Healthcare Provider Details

I. General information

NPI: 1922177260
Provider Name (Legal Business Name): PAUL GREGORY SIMEONE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CLEVELAND AVE STE 709
FORT MYERS FL
33901-5857
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3831
  • Fax: 239-343-2301
Mailing address:
  • Phone: 239-343-3831
  • Fax: 239-343-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4469
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: