Provider Demographics
NPI:1316837479
Name:PRICE, BETH SIMON
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:SIMON
Last Name:PRICE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1250
Mailing Address - Country:US
Mailing Address - Phone:708-613-1132
Mailing Address - Fax:
Practice Address - Street 1:920 175TH ST STE 5
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2077
Practice Address - Country:US
Practice Address - Phone:708-613-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501165531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical