Provider Demographics
NPI:1285942672
Name:ISAAC, JUDY L (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:L
Last Name:ISAAC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MYERS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:NY
Mailing Address - Zip Code:14882-9024
Mailing Address - Country:US
Mailing Address - Phone:607-533-7143
Mailing Address - Fax:
Practice Address - Street 1:33 MYERS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:NY
Practice Address - Zip Code:14882-9024
Practice Address - Country:US
Practice Address - Phone:607-533-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019074103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical