Provider Demographics
NPI:1225252133
Name:SIMON, STUART NATHAN (MSW, LICSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:NATHAN
Last Name:SIMON
Suffix:
Gender:M
Credentials:MSW, LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 BEACON ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1236
Mailing Address - Country:US
Mailing Address - Phone:617-247-3737
Mailing Address - Fax:
Practice Address - Street 1:264 BEACON ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1236
Practice Address - Country:US
Practice Address - Phone:617-247-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1044601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical