Provider Demographics
NPI:1346132099
Name:SIMMONS, ELIZABETH (CADC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MARBLE AVE
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-6054
Mailing Address - Country:US
Mailing Address - Phone:207-975-2121
Mailing Address - Fax:
Practice Address - Street 1:807 CUSHING RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4603
Practice Address - Country:US
Practice Address - Phone:207-975-2121
Practice Address - Fax:207-273-5551
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC8333101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)