Provider Demographics
NPI:1689812984
Name:SIMON, RACHAEL J (LMSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:J
Last Name:SIMON
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 1:531 CLINTON ST
Mailing Address - Street 2:APT. 2R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3313
Mailing Address - Country:US
Mailing Address - Phone:212-677-6081
Mailing Address - Fax:646-602-9369
Practice Address - Street 1:197 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5507
Practice Address - Country:US
Practice Address - Phone:212-533-3570
Practice Address - Fax:646-602-9369
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078284-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245221Medicaid