Provider Demographics
NPI:1831354000
Name:SIMMONS, MARK BENJAMIN (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:BENJAMIN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BRONX RIVER RD APT 3D
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-8012
Mailing Address - Country:US
Mailing Address - Phone:646-234-5073
Mailing Address - Fax:
Practice Address - Street 1:821 BRONX RIVER RD APT 3D
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-8012
Practice Address - Country:US
Practice Address - Phone:646-234-5073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046469-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical