Provider Demographics
NPI:1972177103
Name:SIMON, RAHNIEL ANGELO
Entity Type:Individual
Prefix:
First Name:RAHNIEL
Middle Name:ANGELO
Last Name:SIMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1831
Mailing Address - Country:US
Mailing Address - Phone:201-355-9369
Mailing Address - Fax:
Practice Address - Street 1:55 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1831
Practice Address - Country:US
Practice Address - Phone:201-355-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health