Healthcare Provider Details

I. General information

NPI: 1598330078
Provider Name (Legal Business Name): JOSEPH M SIMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W WOODLAND AVE
YOUNGSTOWN OH
44502-1866
US

IV. Provider business mailing address

209 W WOODLAND AVE
YOUNGSTOWN OH
44502-1866
US

V. Phone/Fax

Practice location:
  • Phone: 330-787-9180
  • Fax:
Mailing address:
  • Phone: 330-307-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: