Provider Demographics
NPI:1972251189
Name:SIMON, JONAH ALEXANDER (LMSW)
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:ALEXANDER
Last Name:SIMON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 SAINT ROCH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-5333
Mailing Address - Country:US
Mailing Address - Phone:219-921-6046
Mailing Address - Fax:
Practice Address - Street 1:5705 SAINT ROCH AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-5333
Practice Address - Country:US
Practice Address - Phone:219-921-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant