Provider Demographics
NPI:1386656254
Name:SIMON, STEVEN G (LCSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:SIMON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 ASPEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3794
Mailing Address - Country:US
Mailing Address - Phone:203-288-7309
Mailing Address - Fax:
Practice Address - Street 1:2348 WHITNEY AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3512
Practice Address - Country:US
Practice Address - Phone:203-287-2488
Practice Address - Fax:203-287-9133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT80003685Medicare ID - Type Unspecified