Provider Demographics
NPI:1437314424
Name:ISAA, IVAN ENRIQUE (CASAC-T)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:ENRIQUE
Last Name:ISAA
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:NAZKANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPA
Mailing Address - Street 1:385 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1033
Mailing Address - Country:US
Mailing Address - Phone:516-935-6858
Mailing Address - Fax:516-935-2717
Practice Address - Street 1:385 W JOHN ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1033
Practice Address - Country:US
Practice Address - Phone:516-935-6858
Practice Address - Fax:516-935-2717
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor