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General NPI Number Information
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NPI Number | 1891276382
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Entity Type | Individual
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Provider Name | JACQUELYN SIMONS MA, LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 119 W 57TH ST STE 1100
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City | NEW YORK
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State | NY
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Zip | 10019-2401
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Country | US
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Telephone | 212-381-4853
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Fax |
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Provider Business Mailing Address
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Address Line | 35 HUDSON ST APT 2311
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City | JERSEY CITY
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State | NJ
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Zip | 07302-7576
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Country | US
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Telephone | 860-614-0643
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 103656
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License Number State | NY
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