Healthcare Provider Details

I. General information

NPI: 1649959529
Provider Name (Legal Business Name): FIONA SIMON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 BECKNER RD
SANTA FE NM
87507-3691
US

IV. Provider business mailing address

2325 CERRILLOS RD
SANTA FE NM
87505-3377
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-4500
  • Fax: 505-438-6011
Mailing address:
  • Phone: 505-438-0010
  • Fax: 505-438-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: