MEDICARE: DR. JONATHAN JOSEPH ISAACSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6226	OH

General Provider Information

NPI Number	:	1346264371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN JOSEPH ISAACSON PH.D.

Provider Business Mailing Address
First Line	:	3659 GREEN RD STE 100
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5715
Country	:	US
Telephone Number	:	216-292-4500
Fax Number	:	216-373-0085

Provider Business Practice Location Address
First Line	:	3659 GREEN RD STE 100
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5715
Country	:	US
Telephone Number	:	216-292-4500
Fax Number	:	216-373-0085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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