Provider Demographics
NPI:1114935137
Name:ISAACS, LUCILLE MARIE (LCSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:MARIE
Last Name:ISAACS
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E DUPONT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2048
Mailing Address - Country:US
Mailing Address - Phone:260-490-8110
Mailing Address - Fax:260-490-7707
Practice Address - Street 1:310 E DUPONT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2048
Practice Address - Country:US
Practice Address - Phone:260-490-8110
Practice Address - Fax:260-490-7707
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002916A1041C0700X
IN35000290A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20030080Medicaid
176540CMedicare ID - Type Unspecified