Healthcare Provider Details

I. General information

NPI: 1528490141
Provider Name (Legal Business Name): NICOLE ISENBERG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 E BASELINE RD
PHOENIX AZ
85042-6551
US

IV. Provider business mailing address

2702 N 3RD ST SUITE 4020
PHOENIX AZ
85004-1130
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 602-243-1235
Mailing address:
  • Phone: 602-323-3345
  • Fax: 602-323-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-10836
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: