Provider Demographics
NPI:1508539883
Name:ISAAC, AVRON (LCSW)
Entity Type:Individual
Prefix:
First Name:AVRON
Middle Name:
Last Name:ISAAC
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 1:323 KERRIGAN BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3455
Mailing Address - Country:US
Mailing Address - Phone:973-348-6148
Mailing Address - Fax:
Practice Address - Street 1:323 KERRIGAN BLVD APT 4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3455
Practice Address - Country:US
Practice Address - Phone:973-348-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-31
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060105001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical