Provider Demographics
NPI:1457099384
Name:DEVORKIN, ISABEL AJA
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:AJA
Last Name:DEVORKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8563 N POINT DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2353
Mailing Address - Country:US
Mailing Address - Phone:414-530-7751
Mailing Address - Fax:
Practice Address - Street 1:4071 BEE RIDGE RD STE 240
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2542
Practice Address - Country:US
Practice Address - Phone:941-357-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health