Provider Demographics
NPI:1073123626
Name:SIMON, YVELINE (LICSW)
Entity Type:Individual
Prefix:
First Name:YVELINE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MIDDLESEX AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2745
Mailing Address - Country:US
Mailing Address - Phone:978-658-9889
Mailing Address - Fax:
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2773
Practice Address - Country:US
Practice Address - Phone:978-658-5695
Practice Address - Fax:978-658-5695
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1226181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical