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Provider Information for 1174070692


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JOSHUA SIMON


Sex: Male

NPI: 1174070692
Last Updated: 2016-09-01
Certification Date:

Details

NameValue
NPI1174070692
Enumeration Date2016-09-01
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 200 SCOTIA DR
APT 103
HYPOLUXO, FL 33462
United States

Phone: | Fax:
 
Primary Practice Address 200 SCOTIA DR
APT 103
HYPOLUXO, FL 33462-6096
United States

Phone: 561-313-5735 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalFLsw13727