Provider Demographics
NPI:1689859258
Name:SIMON, LINDSEY ROSS (MSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:ROSS
Last Name:SIMON
Suffix:
Gender:F
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 1:1656 CHAMPLIN AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4830
Mailing Address - Country:US
Mailing Address - Phone:315-797-6655
Mailing Address - Fax:315-738-9719
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-797-6655
Practice Address - Fax:315-738-9719
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069745-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical