Provider Demographics
NPI:1316392962
Name:ISAAC, LAUREN (MSED)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E 93RD ST
Mailing Address - Street 2:A940
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2353
Mailing Address - Country:US
Mailing Address - Phone:718-844-0227
Mailing Address - Fax:
Practice Address - Street 1:60 E 93RD ST
Practice Address - Street 2:A940
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-2353
Practice Address - Country:US
Practice Address - Phone:718-844-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1003267151252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency