Provider Demographics
NPI:1700521408
Name:JEAN SIMON, PASCALE (LAC)
Entity Type:Individual
Prefix:MS
First Name:PASCALE
Middle Name:
Last Name:JEAN SIMON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5244
Mailing Address - Country:US
Mailing Address - Phone:908-265-3008
Mailing Address - Fax:
Practice Address - Street 1:86 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1748
Practice Address - Country:US
Practice Address - Phone:908-265-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00933100101YP2500X
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No374J00000XNursing Service Related ProvidersDoula