1699803585 NPI number — CONNIE ISEMAN, LCSW, CAP, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699803585 NPI number — CONNIE ISEMAN, LCSW, CAP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNIE ISEMAN, LCSW, CAP, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699803585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 180957
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASSELBERRY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32718-0957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-339-2279
Provider Business Mailing Address Fax Number:
407-830-4548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1375 S SEMORAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 1305
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-339-2279
Provider Business Practice Location Address Fax Number:
407-830-4548
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ISEMAN
Authorized Official First Name:
(MARY )
Authorized Official Middle Name:
CONNIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-339-2279

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW 3513 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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