MEDICARE: DR. STACY LYNN SIMON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS016569	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11919882	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1558596130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY LYNN SIMON PH.D.

Provider Business Mailing Address
First Line	:	6315 FORBES AVE STE L115
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1723
Country	:	US
Telephone Number	:	412-979-2919
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 FORBES AVE STE L115
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1723
Country	:	US
Telephone Number	:	412-979-2919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	06/24/2026

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