Basic Information
| Provider Information | |||||||||
| NPI: | 1760157457 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JONATHAN SIMMONS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 OLD FORGE RD | ||||||||
| Address2: | |||||||||
| City: | NORTH FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025563016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083868508 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 DEPOT AVE | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083868508 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2021 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | SIMMONS | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | BRIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5083868508 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.