Provider Demographics
NPI:1417573684
Name:LANDMAN, ISAAC M
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:M
Last Name:LANDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2767
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-2767
Mailing Address - Country:US
Mailing Address - Phone:617-955-6002
Mailing Address - Fax:
Practice Address - Street 1:1001 COMMONWEALTH DR UNIT 113
Practice Address - Street 2:
Practice Address - City:KINGS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143-4509
Practice Address - Country:US
Practice Address - Phone:617-955-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health