Provider Demographics
NPI:1689050692
Name:SIMON, ANTHONY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E RAMIE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-4436
Mailing Address - Country:US
Mailing Address - Phone:808-701-9734
Mailing Address - Fax:
Practice Address - Street 1:48-3 YONAHA, SHIMAJIRI DISTRICT
Practice Address - Street 2:ROOM #303
Practice Address - City:HAEBARU
Practice Address - State:OKINAWA
Practice Address - Zip Code:9011103
Practice Address - Country:JP
Practice Address - Phone:802-134-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW 2211911041C0700X
FLSW151601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical