MEDICARE: ANGELA SIMON LCSW

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	1041C0700X	Clinical Social Worker	4319	TN

General Provider Information

NPI Number	:	1902992944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SIMON LCSW

Provider Business Mailing Address
First Line	:	1105 GILMORE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-2525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 GILMORE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-2525
Country	:	US
Telephone Number	:	615-322-2028
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	04/20/2020

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