MEDICARE: GAVRIELLE BETH SIMON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC06522600	NJ
2	1041C0700X	Clinical Social Worker	101218	NY

General Provider Information

NPI Number	:	1902548852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAVRIELLE BETH SIMON LCSW

Provider Business Mailing Address
First Line	:	1536 STATE ROUTE 23 # 1021
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7516
Country	:	US
Telephone Number	:	551-237-6768
Fax Number	:

Provider Business Practice Location Address
First Line	:	1536 STATE ROUTE 23 # 1021
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7516
Country	:	US
Telephone Number	:	551-237-6768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	10/11/2025

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