Provider Demographics
NPI:1740586783
Name:SCHLOSSBERG, SIMEON KNOX (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIMEON
Middle Name:KNOX
Last Name:SCHLOSSBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 W JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4615
Mailing Address - Country:US
Mailing Address - Phone:410-812-1462
Mailing Address - Fax:
Practice Address - Street 1:2324 W JOPPA RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4615
Practice Address - Country:US
Practice Address - Phone:410-812-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health