Provider Demographics
NPI:1215328216
Name:WASHINGTON-SIMON, KATAURA TOI
Entity type:Individual
Prefix:MS
First Name:KATAURA
Middle Name:TOI
Last Name:WASHINGTON-SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5350
Mailing Address - Country:US
Mailing Address - Phone:646-526-3224
Mailing Address - Fax:
Practice Address - Street 1:1148 MORNING GLORY DR
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5350
Practice Address - Country:US
Practice Address - Phone:646-526-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00223000101Y00000X
NJ806259101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool