Provider Demographics
NPI:1700037827
Name:SIMON, REGINA ARLENE (LMSW)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ARLENE
Last Name:SIMON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:ARLENE
Other - Last Name:NERIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAADC
Mailing Address - Street 1:2806 DAVENPORT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3734
Mailing Address - Country:US
Mailing Address - Phone:989-752-7867
Mailing Address - Fax:989-752-6830
Practice Address - Street 1:2806 DAVENPORT AVENUE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3734
Practice Address - Country:US
Practice Address - Phone:989-790-7500
Practice Address - Fax:989-752-6830
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089820104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801089820OtherCLINICAL LICENSE