Provider Demographics
NPI:1326702853
Name:SIMON, SCOTT STEPHEN (LMFT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:STEPHEN
Last Name:SIMON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 SUMMER ST APT 2206
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2373
Mailing Address - Country:US
Mailing Address - Phone:203-984-1824
Mailing Address - Fax:
Practice Address - Street 1:184 SUMMER ST APT 2206
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2373
Practice Address - Country:US
Practice Address - Phone:203-984-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist