Individual
SUZANNE SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
95 EXCHANGE ST, NEW ENGLAND FAMILY INSTITUTE, SUITE 100, PORTLAND, ME 04101
(207) 871-1000
(207) 773-0472
Mailing address
67 MAIETTA PARKWAY, UNIT 7, SOUTH PORTLAND, ME 04106
(207) 799-1749
(207) 773-0472
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC2723
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048364
PROVIDER #-ANTHEM
ME
01
—
355527
PROVIDER #-MHN/TRICARE
ME
Enumeration date
08/05/2006
Last updated
07/09/2007
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