Provider Demographics
NPI:1023368586
Name:SIMPSON, MARK DANIEL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DANIEL
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 PORTLAND AVE SOUTH
Mailing Address - Street 2:5TH FLOOR, COPE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-348-5358
Mailing Address - Fax:
Practice Address - Street 1:525 PORTLAND AVE SOUTH
Practice Address - Street 2:5TH FLOOR, COPE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-596-6584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical