Provider Demographics
NPI:1891965026
Name:SIMON, SUSAN L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
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 1:16 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1370
Mailing Address - Country:US
Mailing Address - Phone:732-257-5865
Mailing Address - Fax:
Practice Address - Street 1:16 WELLINGTON CT
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-1370
Practice Address - Country:US
Practice Address - Phone:732-257-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074409-11041C0700X
NJ44SC004300001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical