Provider Demographics
NPI:1427384817
Name:ISAACSON, LEAH C (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:C
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4909
Mailing Address - Country:US
Mailing Address - Phone:207-942-3816
Mailing Address - Fax:207-561-4725
Practice Address - Street 1:29 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4909
Practice Address - Country:US
Practice Address - Phone:207-942-3816
Practice Address - Fax:207-561-4725
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC122831041C0700X
MECAC4716101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1427384817Medicaid