Provider Demographics
NPI:1710030846
Name:ISAACSON, MARILYN NONA (RN, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:NONA
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 S MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2486
Mailing Address - Country:US
Mailing Address - Phone:860-521-0504
Mailing Address - Fax:860-521-0506
Practice Address - Street 1:61 S MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2486
Practice Address - Country:US
Practice Address - Phone:860-521-0504
Practice Address - Fax:860-521-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSW0024801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800001152Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER