Provider Demographics
NPI:1124209689
Name:LUMERMAN, SIMONA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SIMONA
Middle Name:
Last Name:LUMERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GROVE AVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2322
Mailing Address - Country:US
Mailing Address - Phone:516-569-0568
Mailing Address - Fax:
Practice Address - Street 1:123 GROVE AVENUE
Practice Address - Street 2:SUITE #202
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2322
Practice Address - Country:US
Practice Address - Phone:516-569-0568
Practice Address - Fax:516-792-1234
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014320-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVH0161Medicare PIN