MEDICARE: SONJA L SIMPSON MS

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
2	106E00000X	Assistant Behavior Analyst	BH006433	PA

General Provider Information

NPI Number	:	1528695863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA L SIMPSON MS

Provider Business Mailing Address
First Line	:	1242 W AIRDRIE ST APT 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-3707
Country	:	US
Telephone Number	:	484-844-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1242 W AIRDRIE ST APT 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-3707
Country	:	US
Telephone Number	:	484-844-9003
Fax Number	:

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

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	02/25/2025

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