Provider Demographics
NPI:1497822522
Name:SIMON, CAROL MOSES (MSW LCSWC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:MOSES
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSW LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 E EDMONSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-982-7137
Mailing Address - Fax:301-474-0650
Practice Address - Street 1:8955 E EDMONSTON ROAD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-982-7137
Practice Address - Fax:301-474-0650
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD010851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
646699Medicare ID - Type Unspecified