Healthcare Provider Details

I. General information

NPI: 1124558390
Provider Name (Legal Business Name): CLAUDIA YSABEL SIMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MERRIMACK ST STE 120
LAWRENCE MA
01843-1789
US

IV. Provider business mailing address

40 VINE ST APT 2
LAWRENCE MA
01841-2717
US

V. Phone/Fax

Practice location:
  • Phone: 978-620-0290
  • Fax:
Mailing address:
  • Phone: 978-601-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: