Provider Demographics
NPI:1821284001
Name:SIMON, ANITA (EDD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 JONATHAN LANE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110
Mailing Address - Country:US
Mailing Address - Phone:717-695-6719
Mailing Address - Fax:
Practice Address - Street 1:1831 CHESTNUT ST
Practice Address - Street 2:SUITE 801
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:215-756-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003725L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist