Provider Demographics
NPI:1851510069
Name:SIMON, TRACEY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 5TH AVE RM 1306
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6664
Mailing Address - Country:US
Mailing Address - Phone:646-600-9163
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1306
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6664
Practice Address - Country:US
Practice Address - Phone:646-600-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730702341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ52117Medicare UPIN