Provider Demographics
NPI:1174888986
Name:SIMMONS, CRYSTAL (MSED)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4142
Mailing Address - Country:US
Mailing Address - Phone:845-461-3403
Mailing Address - Fax:
Practice Address - Street 1:27 VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4142
Practice Address - Country:US
Practice Address - Phone:845-461-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst