MEDICARE: GARY RAYMOND SIMONEAU 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	101YM0800X	Mental Health Counselor	1027144	MA

General Provider Information

NPI Number	:	1326123506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY RAYMOND SIMONEAU LICSW

Provider Business Mailing Address
First Line	:	117 HUDSON ST
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-2631
Country	:	US
Telephone Number	:	617-629-4632
Fax Number	:

Provider Business Practice Location Address
First Line	:	599 NORTH AVE
Second Line	:	DOOR 8
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-1648
Country	:	US
Telephone Number	:	781-224-9884
Fax Number	:	781-224-9632

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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