Provider Demographics
NPI:1891915690
Name:SIMON, JEANNE I (PHD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:I
Last Name:SIMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 CAMINO DIABLO
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3978
Mailing Address - Country:US
Mailing Address - Phone:925-945-8105
Mailing Address - Fax:925-945-8105
Practice Address - Street 1:2950 CAMINO DIABLO
Practice Address - Street 2:SUITE 120
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3978
Practice Address - Country:US
Practice Address - Phone:925-945-8105
Practice Address - Fax:925-945-8105
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical