Basic Information
| Provider Information | |||||||||
| NPI: | 1477623999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMONS | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.I.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18200 LORAIN AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441115605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164767088 | ||||||||
| FaxNumber: | 2164767323 | ||||||||
| Practice Location | |||||||||
| Address1: | 18200 LORAIN AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441115605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164767088 | ||||||||
| FaxNumber: | 2164767323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I0007163 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | I0007163 | 01 | OH | COUNS SOCIAL WKR BOARD | OTHER |