Healthcare Provider Details

I. General information

NPI: 1821949157
Provider Name (Legal Business Name): LILLY SIMON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E 39TH ST STE 1100
NEW YORK NY
10016-0112
US

IV. Provider business mailing address

6 E 39TH ST STE 1100
NEW YORK NY
10016-0112
US

V. Phone/Fax

Practice location:
  • Phone: 646-944-8108
  • Fax: 646-944-8108
Mailing address:
  • Phone: 646-944-8108
  • Fax: 646-944-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: