Provider Demographics
NPI:1063224269
Name:KOENE, ISABELLE
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:KOENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SOUTHFIELD AVE APT 417
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7662
Mailing Address - Country:US
Mailing Address - Phone:908-752-2520
Mailing Address - Fax:
Practice Address - Street 1:1901 FORT MYER DR STE 1104
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-1609
Practice Address - Country:US
Practice Address - Phone:571-255-9906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health