Provider Demographics
NPI:1346264371
Name:ISAACSON, JONATHAN JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JOSEPH
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:CHARLES
Other - Last Name:LENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3659 GREEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5715
Mailing Address - Country:US
Mailing Address - Phone:216-292-4500
Mailing Address - Fax:216-373-0085
Practice Address - Street 1:3659 GREEN RD STE 100
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5715
Practice Address - Country:US
Practice Address - Phone:216-292-4500
Practice Address - Fax:216-373-0085
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6226103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical