Provider Demographics
NPI:1942487301
Name:SIMON, GLORIA SUSAN
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:SUSAN
Last Name:SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 PARADISO CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1950
Mailing Address - Country:US
Mailing Address - Phone:973-771-8905
Mailing Address - Fax:973-771-3180
Practice Address - Street 1:3718 PARADISO CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-1950
Practice Address - Country:US
Practice Address - Phone:607-759-3312
Practice Address - Fax:973-771-3180
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040111991041C0700X
1041C0700X
NJ44SC055096001041C0700X
NY00078986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical