1205086543 NPI number — MRS. ALISON BERNS SIMON MSW, LCSW, BCD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205086543 NPI number — MRS. ALISON BERNS SIMON MSW, LCSW, BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNS SIMON
Provider First Name:
ALISON
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNS
Provider Other First Name:
ALISON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205086543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 GLEN COVE RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ROSLYN HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11577-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-626-2517
Provider Business Mailing Address Fax Number:
516-626-2085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 GLEN COVE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ROSLYN HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11577-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-626-2517
Provider Business Practice Location Address Fax Number:
516-626-2085
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  069573 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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