Provider Demographics
NPI:1053439927
Name:SIMON, STEVEN ELLIOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ELLIOTT
Last Name:SIMON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 LAGO VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3329
Mailing Address - Country:US
Mailing Address - Phone:727-784-7650
Mailing Address - Fax:727-781-1336
Practice Address - Street 1:101 PHILLIPPE PKWY
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3660
Practice Address - Country:US
Practice Address - Phone:727-784-7650
Practice Address - Fax:727-781-1336
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002356101YP2500X
OHE0000520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional