Provider Demographics
NPI:1780202846
Name:ISAKSEN, IMARI-ASHLEY PALMA (PHD)
Entity Type:Individual
Prefix:DR
First Name:IMARI-ASHLEY
Middle Name:PALMA
Last Name:ISAKSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:IMARI-ASHLEY
Other - Middle Name:FULACHE
Other - Last Name:PALMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-919-4637
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-919-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11349103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist