MEDICARE: STEPHEN C SIMMER LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	107555	MA

General Provider Information

NPI Number	:	1326051491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN C SIMMER LICSW

Provider Business Mailing Address
First Line	:	351 PLEASANT ST
Second Line	:	PMB 255
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-3900
Country	:	US
Telephone Number	:	413-731-7262
Fax Number	:	413-731-8788

Provider Business Practice Location Address
First Line	:	380 UNION ST
Second Line	:	STE 19
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-4123
Country	:	US
Telephone Number	:	413-731-7262
Fax Number	:	413-731-8788

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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