Provider Demographics
NPI:1083748172
Name:SIMONS, BRUCE ROLAND (PHD)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ROLAND
Last Name:SIMONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-1716
Mailing Address - Country:US
Mailing Address - Phone:814-772-5546
Mailing Address - Fax:814-772-0511
Practice Address - Street 1:102 CENTER ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-1716
Practice Address - Country:US
Practice Address - Phone:814-772-5546
Practice Address - Fax:814-772-0511
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-015091103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)