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General NPI Number Information
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NPI Number | 1336659879
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Entity Type | Organization
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Legal Business Name | VALERIE SIMON D/B/A THE INNER STAGE
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 57 W 57TH ST STE 704
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City | NEW YORK
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State | NY
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Zip | 10019-2802
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Country | US
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Telephone | 917-572-8114
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Fax |
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Provider Business Mailing Address
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Address Line | 57 W 57TH ST STE 704
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City | NEW YORK
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State | NY
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Zip | 10019-2802
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Country | US
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Telephone | 917-572-8114
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VALERIE SIMON
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Credential |
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Telephone | 917-572-8114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 056118
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License Number State | NY
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