Provider Demographics
NPI:1215579339
Name:SIMON, SANDRA JEAN (CSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:SIMON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3712
Mailing Address - Country:US
Mailing Address - Phone:510-231-6564
Mailing Address - Fax:
Practice Address - Street 1:1275 HALL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-3712
Practice Address - Country:US
Practice Address - Phone:510-231-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker