Provider Demographics
NPI:1740017417
Name:SIMON, ERIN ELISABETH
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELISABETH
Last Name:SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11436 W CLUBVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-3711
Mailing Address - Country:US
Mailing Address - Phone:863-226-9193
Mailing Address - Fax:
Practice Address - Street 1:11436 W CLUBVIEW DR
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-3711
Practice Address - Country:US
Practice Address - Phone:863-226-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health