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General NPI Number Information
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NPI Number | 1801992367
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Entity Type | Individual
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Provider Name | TRACY LEIGH SIMON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 128 WOOSTER ST SUITE 4
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City | NEW YORK
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State | NY
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Zip | 10012-3809
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Country | US
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Telephone | 212-343-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 417 1ST ST APT # 4
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City | BROOKLYN
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State | NY
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Zip | 11215-2507
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Country | US
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Telephone | 917-685-6636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0158541
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License Number State | NY
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