Provider Demographics
NPI:1619419462
Name:ISAAK, EUGENE DENNIS
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:DENNIS
Last Name:ISAAK
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 1:1607 MAIN ST
Mailing Address - Street 2:APT A 323
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1234
Mailing Address - Country:US
Mailing Address - Phone:508-361-1847
Mailing Address - Fax:
Practice Address - Street 1:1607 MAIN ST
Practice Address - Street 2:APT A 323
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1234
Practice Address - Country:US
Practice Address - Phone:508-361-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)