Healthcare Provider Details

I. General information

NPI: 1457133670
Provider Name (Legal Business Name): JENNIFER SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11883 PERRY HWY STE D
WEXFORD PA
15090-7353
US

IV. Provider business mailing address

35 LAUREL RD
BRADFORDWOODS PA
15015-1207
US

V. Phone/Fax

Practice location:
  • Phone: 724-987-2993
  • Fax:
Mailing address:
  • Phone: 724-272-0514
  • Fax: 724-272-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: