Provider Demographics
NPI:1083213144
Name:PUTMAN, ISAIAH DAVID
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:DAVID
Last Name:PUTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4406
Mailing Address - Country:US
Mailing Address - Phone:210-617-8746
Mailing Address - Fax:
Practice Address - Street 1:236 W 64TH ST APT 2H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6433
Practice Address - Country:US
Practice Address - Phone:210-617-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty