Healthcare Provider Details

I. General information

NPI: 1588030233
Provider Name (Legal Business Name): SIMON DAVIS-MILLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEYMOUTH ST STE D
ROCKLAND MA
02370-1145
US

IV. Provider business mailing address

220 FORBES RD STE 204
BRAINTREE MA
02184-2712
US

V. Phone/Fax

Practice location:
  • Phone: 508-289-1787
  • Fax:
Mailing address:
  • Phone: 781-417-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: