Provider Demographics
NPI:1851503247
Name:FOSTER, ISABELLE CLARK (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ISABELLE
Middle Name:CLARK
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ISABELLE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:85 BRUSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1447
Mailing Address - Country:US
Mailing Address - Phone:413-528-6722
Mailing Address - Fax:
Practice Address - Street 1:85 BRUSH HILL RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1447
Practice Address - Country:US
Practice Address - Phone:413-528-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1114021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1859951Medicaid
MA1859951Medicaid