Provider Demographics
NPI:1205848876
Name:YOUCHA, ISAAC ZEKE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:ZEKE
Last Name:YOUCHA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2700
Mailing Address - Country:US
Mailing Address - Phone:212-348-9595
Mailing Address - Fax:212-348-9595
Practice Address - Street 1:153 E 87TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2700
Practice Address - Country:US
Practice Address - Phone:212-348-9595
Practice Address - Fax:212-348-9595
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00795111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19361Medicare ID - Type Unspecified