Provider Demographics
NPI:1760917538
Name:LOGAN, ISABEL (LCSW)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 PROSPECT AVE
Mailing Address - Street 2:206
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4288
Mailing Address - Country:US
Mailing Address - Phone:860-550-1539
Mailing Address - Fax:
Practice Address - Street 1:674 PROSPECT AVE
Practice Address - Street 2:206
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4288
Practice Address - Country:US
Practice Address - Phone:860-550-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical