Provider Demographics
NPI:1659712966
Name:SIMONE, STACY MARIE (MS SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:SIMONE
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NORTH END AVENUE, #2L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282
Mailing Address - Country:US
Mailing Address - Phone:973-975-3025
Mailing Address - Fax:
Practice Address - Street 1:300 N END AVE APT 2L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282-1267
Practice Address - Country:US
Practice Address - Phone:973-975-3025
Practice Address - Fax:973-975-3025
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 022938235Z00000X
NY022938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist