Provider Demographics
NPI:1811019441
Name:ISAACS, CAROLINE (MFT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:ISAACS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4829
Mailing Address - Country:US
Mailing Address - Phone:707-444-0927
Mailing Address - Fax:
Practice Address - Street 1:2625 WILSON ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4829
Practice Address - Country:US
Practice Address - Phone:707-444-0927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ40983ZOtherBLUE SHIELD OF CA PIN