1689050692 NPI number — ANTHONY SIMON M.S.W., L.C.S.W.

Table of content: ANTHONY SIMON M.S.W., L.C.S.W. (NPI 1689050692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689050692 NPI number — ANTHONY SIMON M.S.W., L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
ANTHONY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., L.C.S.W.
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1689050692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 E RAMIE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65202-4436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-701-9734
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48-3 YONAHA, SHIMAJIRI DISTRICT
Provider Second Line Business Practice Location Address:
ROOM #303
Provider Business Practice Location Address City Name:
HAEBARU
Provider Business Practice Location Address State Name:
OKINAWA
Provider Business Practice Location Address Postal Code:
9011103
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
802-134-8359
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2015

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:  LCSW 221191 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: SW15160 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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