MEDICARE: MS. LUCILLE MARIE ISAACS LCSW LMFT

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	1041C0700X	Clinical Social Worker	34002916A	IN
2	106H00000X	Marriage & Family Therapist	35000290A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114935137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUCILLE MARIE ISAACS LCSW LMFT

Provider Business Mailing Address
First Line	:	310 E DUPONT RD
Second Line	:	SUITE 2
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2048
Country	:	US
Telephone Number	:	260-490-8110
Fax Number	:	260-490-7707

Provider Business Practice Location Address
First Line	:	310 E DUPONT RD
Second Line	:	SUITE 2
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2048
Country	:	US
Telephone Number	:	260-490-8110
Fax Number	:	260-490-7707

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	09/11/2025

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