Healthcare Provider Details

I. General information

NPI: 1124935788
Provider Name (Legal Business Name): MAIA SIMMONS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST STE C105
DANVERS MA
01923-2765
US

IV. Provider business mailing address

74 NEWHALL ST APT 3
LYNN MA
01902-3474
US

V. Phone/Fax

Practice location:
  • Phone: 978-626-3336
  • Fax:
Mailing address:
  • Phone: 484-844-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1601094
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: