Provider Demographics
NPI:1821639576
Name:SIMON, ESTHER (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HILLSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3798
Mailing Address - Country:US
Mailing Address - Phone:732-534-7325
Mailing Address - Fax:732-523-0060
Practice Address - Street 1:80 HILLSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3798
Practice Address - Country:US
Practice Address - Phone:732-534-7325
Practice Address - Fax:732-523-0060
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-19-38217103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty