Basic Information
| Provider Information | |||||||||
| NPI: | 1740641505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEYNE | ||||||||
| FirstName: | SIMONE | ||||||||
| MiddleName: | SAMANTA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PEER SPACIALIST | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALLEYNE | ||||||||
| OtherFirstName: | SIMONE | ||||||||
| OtherMiddleName: | SAMANTA | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PEER SPECIALIST | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9-15 ADRIAN AVE APT4J | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186795427 | ||||||||
| FaxNumber: | 7188842901 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 ADRIAN AVE APT 4J | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104636561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188842992 | ||||||||
| FaxNumber: | 7188842901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2016 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NYCPS-P247 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.