| Doctor Name: | MR. BRUCE ROLAND SIMONS |
| NPI Number: | 1083748172 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PS-015091 |
| Business Practice Address: | 102 Center St Ridgway, PA - 158531716 |
| Business Phone Number: | 8147725546 |
| Business Fax Number: | 8147720511 |
| Mailing Address: | 102 Center St, RIDGWAY |
| State: | PA |
| Postal Code: | 158531716 |
| Phone Number: | 8147725546 |
| Fax Number: | 8147720511 |
| NPI Enumeration Date: | 03/14/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | PS-015091 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |