Provider Demographics
NPI:1649047309
Name:NEUFANG, ISABELLA MARIA (MA, LLC)
Entity type:Individual
Prefix:MS
First Name:ISABELLA
Middle Name:MARIA
Last Name:NEUFANG
Suffix:
Gender:F
Credentials:MA, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W UNIVERSITY DR STE A-2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1817
Mailing Address - Country:US
Mailing Address - Phone:248-266-0920
Mailing Address - Fax:
Practice Address - Street 1:900 W UNIVERSITY DR STE A-2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1817
Practice Address - Country:US
Practice Address - Phone:248-266-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023960101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional