Provider Demographics
NPI:1932238177
Name:SIMON, BETH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 DORSEY HALL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7749
Mailing Address - Country:US
Mailing Address - Phone:410-715-1180
Mailing Address - Fax:410-715-1182
Practice Address - Street 1:4801 DORSEY HALL DR STE 200
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7749
Practice Address - Country:US
Practice Address - Phone:410-715-1180
Practice Address - Fax:410-715-1182
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD028011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical