Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1181 | MA |
N | 1041C0700X | Clinical Social Worker | 111795 | MA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 7234 | CT |
N | 363LP2300X | Nurse Practitioner - Primary Care | MS1125839N | MA |
NPI | 1053497206 |
---|---|
Provider Name | Renee Simone |
First Address | Chicopee, MA 01020-1139 |
Second Address | Chicopee, MA 01020-1139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 29/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1036490 | NHP (01) | MA |
1053497206 | (05) | CT |
1853171 | (05) | MA |
2197528 | CIGNA (01) | MA |
726247000 | MAGELLAN (01) | MA |
861096515 | AETNA (01) | MA |
P08297 | BC/BS (01) | MA |