Provider Demographics
NPI:1902548852
Name:SIMON, GAVRIELLE BETH (LCSW)
Entity type:Individual
Prefix:
First Name:GAVRIELLE
Middle Name:BETH
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GAVRIELLE
Other - Middle Name:BETH
Other - Last Name:CANTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCW
Mailing Address - Street 1:1536 STATE ROUTE 23 # 1021
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7516
Mailing Address - Country:US
Mailing Address - Phone:551-237-6768
Mailing Address - Fax:
Practice Address - Street 1:1536 STATE ROUTE 23 # 1021
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7516
Practice Address - Country:US
Practice Address - Phone:551-237-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC065226001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical