Healthcare Provider Details

I. General information

NPI: 1336599745
Provider Name (Legal Business Name): STACEY ANN ISAACSON LCAT ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 MONTGOMERY ST FL 2
RHINEBECK NY
12572-1356
US

IV. Provider business mailing address

6402 MONTGOMERY ST FL 2
RHINEBECK NY
12572-1356
US

V. Phone/Fax

Practice location:
  • Phone: 845-444-1727
  • Fax:
Mailing address:
  • Phone: 845-444-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001502
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: