Healthcare Provider Details

I. General information

NPI: 1891412664
Provider Name (Legal Business Name): SARAH A SIMON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W HAWTHORNE AVE
VALLEY STREAM NY
11580-6223
US

IV. Provider business mailing address

14724 71ST AVE APT A
FLUSHING NY
11367-2009
US

V. Phone/Fax

Practice location:
  • Phone: 516-569-6600
  • Fax:
Mailing address:
  • Phone: 516-606-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: