Provider Demographics
NPI:1730556010
Name:SIMMONS, DEREK XAVIER
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:XAVIER
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PITTMAN LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2009
Mailing Address - Country:US
Mailing Address - Phone:551-998-1216
Mailing Address - Fax:
Practice Address - Street 1:2 PITTMAN LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2009
Practice Address - Country:US
Practice Address - Phone:551-998-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health