Provider Demographics
NPI:1750048427
Name:SIMON, MICHELLE JANE (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JANE
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MICKIE
Other - Middle Name:JANE
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5402 CONNECTICUT AVE NW STE 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2830
Mailing Address - Country:US
Mailing Address - Phone:202-251-9575
Mailing Address - Fax:
Practice Address - Street 1:5402 CONNECTICUT AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2830
Practice Address - Country:US
Practice Address - Phone:202-251-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD091651041C0700X
DCLC3028581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical