Organization
BE4AU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALANNA SIMMONS LCSW (DIRECTOR)
(612) 413-4087
Entity
Organization
Contact information
Practice address
6249 HAZEL AVE, PHILADELPHIA, PA 19143-1022
(267) 257-4488
Mailing address
30 N GOULD ST STE N, SHERIDAN, WY 82801-6317
(267) 257-4488
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
02/03/2026
Last updated
02/03/2026
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