Provider Demographics
NPI:1629127592
Name:ISAACS, IRWIN I (MS)
Entity Type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:I
Last Name:ISAACS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9641 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4845
Mailing Address - Country:US
Mailing Address - Phone:954-236-0777
Mailing Address - Fax:954-236-2828
Practice Address - Street 1:8320 W SUNRISE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5435
Practice Address - Country:US
Practice Address - Phone:954-236-0777
Practice Address - Fax:954-236-0777
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health