Provider Demographics
NPI:1912043449
Name:SIMON, EILEEN HELEN (MS MAS DMIN)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:HELEN
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS MAS DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29092
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017
Mailing Address - Country:US
Mailing Address - Phone:202-526-0790
Mailing Address - Fax:
Practice Address - Street 1:3999 14TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-526-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0157101YP2500X
DCPRC946101YP2500X
OHC0004482101YP2500X
MIL907794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional