Provider Demographics
NPI:1245252170
Name:SHAOUL, SIMONE CORRADI (MSW-LCSW)
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:CORRADI
Last Name:SHAOUL
Suffix:
Gender:F
Credentials:MSW-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1726
Mailing Address - Country:US
Mailing Address - Phone:914-937-6580
Mailing Address - Fax:914-937-7262
Practice Address - Street 1:910 E BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-4109
Practice Address - Country:US
Practice Address - Phone:914-937-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029053-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN48301Medicare ID - Type Unspecified