Provider Demographics
NPI:1174722102
Name:SIMON, STEPHEN E (LCSW C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:SIMON
Suffix:
Gender:M
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5302
Mailing Address - Country:US
Mailing Address - Phone:301-694-8684
Mailing Address - Fax:301-694-2984
Practice Address - Street 1:13 E 2ND ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5302
Practice Address - Country:US
Practice Address - Phone:301-694-8684
Practice Address - Fax:301-694-2984
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical