MEDICARE: ERICA SIMMONS

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	103K00000X	Behavior Analyst		PA

General Provider Information

NPI Number	:	1700392370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA SIMMONS

Provider Business Mailing Address
First Line	:	1418 BEECHVIEW AVE APT 2
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-3334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 BEECHVIEW AVE APT 2
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-3334
Country	:	US
Telephone Number	:	412-953-1564
Fax Number	:

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

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	12/19/2017

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Directions to “ ERICA SIMMONS ” Practice Location

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