Provider Demographics
NPI:1457153231
Name:SIMONE, SAGE GIDEON
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:GIDEON
Last Name:SIMONE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N DIVISION ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4282
Mailing Address - Country:US
Mailing Address - Phone:410-279-1689
Mailing Address - Fax:
Practice Address - Street 1:308 N DIVISION ST APT 7
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4282
Practice Address - Country:US
Practice Address - Phone:410-279-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool