Provider Demographics
NPI:1184179244
Name:SIMON, ROBERT (LLMSW, CAADC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:LLMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4926
Mailing Address - Country:US
Mailing Address - Phone:248-592-2300
Mailing Address - Fax:248-592-2310
Practice Address - Street 1:6555 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4926
Practice Address - Country:US
Practice Address - Phone:248-592-2300
Practice Address - Fax:248-592-2310
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100045101YA0400X
MI68511000451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)