Healthcare Provider Details

I. General information

NPI: 1487953329
Provider Name (Legal Business Name): JEWELL M SIMMONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 WARREN ST
ROXBURY MA
02119-1833
US

IV. Provider business mailing address

35 ELM ST APT. 8
FOXBORO MA
02035-2516
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-7400
  • Fax:
Mailing address:
  • Phone: 617-970-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number213468
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: