Provider Demographics
NPI:1922534817
Name:SIMANOVICH, STEFAN J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:J
Last Name:SIMANOVICH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WESTCOTT RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3629
Mailing Address - Country:US
Mailing Address - Phone:828-461-2626
Mailing Address - Fax:
Practice Address - Street 1:3434 77TH ST
Practice Address - Street 2:6J
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2339
Practice Address - Country:US
Practice Address - Phone:828-461-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095689104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker