Healthcare Provider Details

I. General information

NPI: 1447112503
Provider Name (Legal Business Name): CHERLIN SIMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 WESTERN AVE APT 227
OMAHA NE
68114-2245
US

IV. Provider business mailing address

9205 WESTERN AVE APT 227
OMAHA NE
68114-2245
US

V. Phone/Fax

Practice location:
  • Phone: 862-293-6540
  • Fax:
Mailing address:
  • Phone: 862-293-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: