Healthcare Provider Details

I. General information

NPI: 1164198560
Provider Name (Legal Business Name): BARBARA DEVON EISEN SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BARBARA SIMON

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25700 SCIENCE PARK DR STE 210
BEACHWOOD OH
44122-7328
US

IV. Provider business mailing address

PO BOX 844020
DALLAS TX
75284-4020
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-1613
  • Fax:
Mailing address:
  • Phone: 216-450-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1100499
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2507374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: