Provider Demographics
NPI:1952791840
Name:SIMON, MELISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16530 VENTURA BLVD
Mailing Address - Street 2:200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4554
Mailing Address - Country:US
Mailing Address - Phone:619-838-4874
Mailing Address - Fax:
Practice Address - Street 1:16530 VENTURA BLVD
Practice Address - Street 2:200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4554
Practice Address - Country:US
Practice Address - Phone:619-838-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical