Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1386309524 |
---|---|
Provider Name | Erik J Simmons |
First Address | Philadelphia, PA 19141-3607 |
Second Address | Philadelphia, PA 19141-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2021 |
Last Update Date | 02/11/2021 |