Provider Demographics
NPI:1760511554
Name:SIMON, FERN DEBRA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:FERN
Middle Name:DEBRA
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 GLOVER PL
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3505
Mailing Address - Country:US
Mailing Address - Phone:516-546-0102
Mailing Address - Fax:516-546-2684
Practice Address - Street 1:732 GLOVER PL
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3505
Practice Address - Country:US
Practice Address - Phone:516-546-0102
Practice Address - Fax:516-546-2684
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045230-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY290-902000OtherMAGELLAN
NYA349806OtherVALUE OPTIONS
NY7373255OtherAETNA
NY7481514OtherGHI
NY225747586OtherUNITED BEHAVIORAL HEALTH
NYP2063316OtherOXFORD
NYN7B721OtherBLUE CROSS BLUE SHIELD
NY225747586OtherUNITED BEHAVIORAL HEALTH
NY7481514OtherGHI
NY1760511664Medicare UPIN