1598044620 NPI number — MS. SIMONE ELISABETH CROMWELL MA, LMFTTC

Table of content: MS. SIMONE ELISABETH CROMWELL MA, LMFTTC (NPI 1598044620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598044620 NPI number — MS. SIMONE ELISABETH CROMWELL MA, LMFTTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROMWELL
Provider First Name:
SIMONE
Provider Middle Name:
ELISABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFTTC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598044620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 92
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BLUE HILL
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04629-0092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-374-2137
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 HARLOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-668-8678
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  TXM3837 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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