Fern Debra Simon, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R045230-1 Issued in NY

Practice address

732 Glover PL
Baldwin, NY 11510-3505

Phone

(516) 546-0102

Fax

(516) 546-2684

NPI assigned

Mar 5, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Preservation Services of Long Island,Inc.

  • Voluntary or Charitable Agency
  • Baldwin, NY
  • NPI 1780071134
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447718400000",
    "number": "1760511554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 GLOVER PL",
            "city": "BALDWIN",
            "state": "NY",
            "postal_code": "115103505",
            "telephone_number": "516-546-0102",
            "fax_number": "516-546-2684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 GLOVER PL",
            "city": "BALDWIN",
            "state": "NY",
            "postal_code": "115103505",
            "telephone_number": "516-546-0102",
            "fax_number": "516-546-2684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "FERN",
        "middle_name": "DEBRA",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2015-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R045230-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "290-902000",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "A349806",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7373255",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "7481514",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "225747586",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2063316",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "N7B721",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric Shoenfeld, M.D.
• Marianna Shooshani
• Nicholas Edward Sieban, LCSW
• Mitza Simeon
• Bruce Simmons, D.P.M.
• Matthew Simon, D.D.S.
• Kristin Simone
• Deena Soliman
• Jill Soller
• Sonia Somers

• Clinical Social Worker in Baldwin, NY
• Providers in Baldwin, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.