Provider Demographics
NPI:1336210442
Name:SIMON, STEPHANIE RAE (LCSW, NCPSYA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RAE
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW, NCPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W 94TH ST
Mailing Address - Street 2:APT. 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6867
Mailing Address - Country:US
Mailing Address - Phone:212-666-3846
Mailing Address - Fax:212-666-3846
Practice Address - Street 1:301 S LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3932
Practice Address - Country:US
Practice Address - Phone:908-403-6516
Practice Address - Fax:201-418-7017
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043077001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical