Provider Demographics
NPI:1336169408
Name:BORGER, SIMON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:
Last Name:BORGER
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 1:4561 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3208
Mailing Address - Country:US
Mailing Address - Phone:858-229-0168
Mailing Address - Fax:858-581-5788
Practice Address - Street 1:1959 GRAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4511
Practice Address - Country:US
Practice Address - Phone:858-229-0168
Practice Address - Fax:858-581-5788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA186791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW186790Medicaid