Provider Demographics
NPI:1922298603
Name:SIMON, MARY MARGARET (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5038
Mailing Address - Country:US
Mailing Address - Phone:208-319-6948
Mailing Address - Fax:208-367-9242
Practice Address - Street 1:1412 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5038
Practice Address - Country:US
Practice Address - Phone:208-319-6948
Practice Address - Fax:208-367-9242
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
COLCSW-9920861041C0700X
IDLCSW-279371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical