Provider Demographics
NPI:1407235799
Name:ISENSTADT, PAUL M (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:ISENSTADT
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 1:2135 SOUTHGATE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-2605
Mailing Address - Country:US
Mailing Address - Phone:719-633-7100
Mailing Address - Fax:719-633-7170
Practice Address - Street 1:2135 SOUTHGATE RD STE 209
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2605
Practice Address - Country:US
Practice Address - Phone:719-633-7100
Practice Address - Fax:719-633-7170
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9840211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical