Healthcare Provider Details

I. General information

NPI: 1447792718
Provider Name (Legal Business Name): AMY ELIZABETH SIMMONS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MALLARD CT
BECKLEY WV
25801
US

IV. Provider business mailing address

28 MALLARD CT
BECKLEY WV
25801-3664
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8409
  • Fax:
Mailing address:
  • Phone: 304-252-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00944675
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: