Provider Demographics
NPI:1538368758
Name:SIMON, CHINYU Y (LSW)
Entity type:Individual
Prefix:MS
First Name:CHINYU
Middle Name:Y
Last Name:SIMON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:CHIN-YU
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:155 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2418
Mailing Address - Country:US
Mailing Address - Phone:330-678-3006
Mailing Address - Fax:330-677-7047
Practice Address - Street 1:155 N WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2418
Practice Address - Country:US
Practice Address - Phone:330-678-3006
Practice Address - Fax:330-677-7047
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 00312061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical