=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992843486
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNETTE ZAFFOS SIMON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 FRANKLIN AVENUE SUITE 211
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-840-1033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 MORTON BLVD
-----------------------------------------------------
City | PLAINVIEW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11803-5616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-939-0689
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R0238231
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------