Healthcare Provider Details

I. General information

NPI: 1831020619
Provider Name (Legal Business Name): CARLA SIMON-HENRIQUEZ NP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN ST
WORCESTER MA
01610-2473
US

IV. Provider business mailing address

26 QUEEN ST
WORCESTER MA
01610-2473
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5678
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: