Healthcare Provider Details

I. General information

NPI: 1851750269
Provider Name (Legal Business Name): BRITTANY SIMONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W FARWELL AVE APT 2
CHICAGO IL
60626-3726
US

IV. Provider business mailing address

1310 W FARWELL AVE APT 2
CHICAGO IL
60626-3726
US

V. Phone/Fax

Practice location:
  • Phone: 408-449-3140
  • Fax:
Mailing address:
  • Phone: 408-449-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149.022700
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: