Provider Demographics
NPI:1790957553
Name:ISEMAN, ELIZABETH D (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:ISEMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 70
Mailing Address - Street 2:
Mailing Address - City:QUAKER STREET
Mailing Address - State:NY
Mailing Address - Zip Code:12141-0070
Mailing Address - Country:US
Mailing Address - Phone:518-657-9061
Mailing Address - Fax:518-895-2615
Practice Address - Street 1:10284 DUANESBURG RD.
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053
Practice Address - Country:US
Practice Address - Phone:518-872-3028
Practice Address - Fax:518-895-2615
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1693101YA0400X
NYR0282821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)