MEDICARE: DR. STEVEN JOEL ISENBERG ED.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	103TC1900X	Counseling Psychologist	3027	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1018190	OTHER	MA	FALLON HEALTHCARE
2	W03256	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1518045582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN JOEL ISENBERG ED.D.

Provider Business Mailing Address
First Line	:	259 MASSACHUSETTS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-8406
Country	:	US
Telephone Number	:	781-648-1848
Fax Number	:	978-371-4997

Provider Business Practice Location Address
First Line	:	259 MASSACHUSETTS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-8406
Country	:	US
Telephone Number	:	781-648-1848
Fax Number	:	978-371-4997

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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