Provider Demographics
NPI:1528794864
Name:STAUBER, SIMON (PSYD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:STAUBER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5123
Mailing Address - Country:US
Mailing Address - Phone:347-372-4043
Mailing Address - Fax:
Practice Address - Street 1:1278 60TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4929
Practice Address - Country:US
Practice Address - Phone:718-686-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program