Provider Demographics
NPI:1699492835
Name:SIMON, ELIEZER (RBT)
Entity type:Individual
Prefix:MR
First Name:ELIEZER
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 CORPORATE WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-203-0714
Mailing Address - Fax:561-375-5006
Practice Address - Street 1:5840 CORPORATE WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-203-0714
Practice Address - Fax:561-375-5006
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-232782103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst