Provider Demographics
NPI:1245605518
Name:SIMON, ANTIONNETTE (MA,MSW)
Entity Type:Individual
Prefix:
First Name:ANTIONNETTE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 ELMWOOD PARK BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3347
Mailing Address - Country:US
Mailing Address - Phone:504-733-0009
Mailing Address - Fax:504-733-0012
Practice Address - Street 1:824 ELMWOOD PARK BLVD STE 150
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123
Practice Address - Country:US
Practice Address - Phone:504-733-0009
Practice Address - Fax:504-733-0012
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health