Provider Demographics
NPI:1124483870
Name:SIMMONS, MINDY MELINDA (MSW)
Entity type:Individual
Prefix:MS
First Name:MINDY
Middle Name:MELINDA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BROOKVIEW ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2704
Mailing Address - Country:US
Mailing Address - Phone:857-222-4439
Mailing Address - Fax:
Practice Address - Street 1:794 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2319
Practice Address - Country:US
Practice Address - Phone:617-534-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical