Provider Demographics
NPI:1881925113
Name:SIMON, ILENE CARYN (MSW, MPH, PHD)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:CARYN
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSW, MPH, PHD
Other - Prefix:
Other - First Name:ILENE
Other - Middle Name:CARYN
Other - Last Name:SIMON SOLOMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1626 WESTWOOD BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5621
Mailing Address - Country:US
Mailing Address - Phone:310-470-7957
Mailing Address - Fax:
Practice Address - Street 1:1626 WESTWOOD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5621
Practice Address - Country:US
Practice Address - Phone:310-470-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical