Provider Demographics
NPI:1306854807
Name:ISAACMAN, STEPHEN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:ISAACMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2007
Mailing Address - Country:US
Mailing Address - Phone:310-652-7373
Mailing Address - Fax:
Practice Address - Street 1:519 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-2007
Practice Address - Country:US
Practice Address - Phone:310-652-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist