Provider Demographics
NPI:1407857261
Name:SIMON, JUDITH T (LCSW, DSC, MSW)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:T
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW, DSC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SIMPSON PL
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1760
Mailing Address - Country:US
Mailing Address - Phone:631-751-2561
Mailing Address - Fax:
Practice Address - Street 1:8 SIMPSON PL
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1760
Practice Address - Country:US
Practice Address - Phone:631-751-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0693451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical