Provider Demographics
NPI:1386075075
Name:DEBORAH GAIL SIMON
Entity type:Organization
Organization Name:DEBORAH GAIL SIMON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-999-3209
Mailing Address - Street 1:664 PROSPECT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4203
Mailing Address - Country:US
Mailing Address - Phone:860-999-3209
Mailing Address - Fax:
Practice Address - Street 1:16 OLD MILL CT
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1948
Practice Address - Country:US
Practice Address - Phone:860-999-3209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty