Provider Demographics
NPI:1255801254
Name:HARVEY, SIMONE (DSP I DSP II, FA,CPI)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:DSP I DSP II, FA,CPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S MEADOW LN APT 223
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6478
Mailing Address - Country:US
Mailing Address - Phone:323-382-9738
Mailing Address - Fax:
Practice Address - Street 1:9333 BASELINE RD STE 290
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1300
Practice Address - Country:US
Practice Address - Phone:909-755-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician