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General NPI Number Information
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NPI Number | 1922169747
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Entity Type | Individual
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Provider Name | DEBORAH SIMON LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 60 AVON MEADOW LN 2ND FLOOR
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City | AVON
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State | CT
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Zip | 06001-3744
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Country | US
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Telephone | 860-999-3209
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Fax |
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Provider Business Mailing Address
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Address Line | 16 OLD MILL CT
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City | SIMSBURY
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State | CT
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Zip | 06070-1948
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Country | US
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Telephone | 860-999-3209
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R035898-1
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License Number State | NY
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