Provider Demographics
NPI:1467731810
Name:SIMEON, TOLA (LMSW)
Entity Type:Individual
Prefix:
First Name:TOLA
Middle Name:
Last Name:SIMEON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84B ANDROS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2047
Mailing Address - Country:US
Mailing Address - Phone:347-857-0775
Mailing Address - Fax:
Practice Address - Street 1:194 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1926
Practice Address - Country:US
Practice Address - Phone:718-390-0561
Practice Address - Fax:718-390-5166
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071435-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker