Provider Demographics
NPI:1316787120
Name:ISMAN, HALEY J (RADT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:J
Last Name:ISMAN
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 E ROUTE 66 STE 106
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3783
Mailing Address - Country:US
Mailing Address - Phone:626-594-0881
Mailing Address - Fax:
Practice Address - Street 1:1340 E ROUTE 66 STE 106
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3783
Practice Address - Country:US
Practice Address - Phone:626-594-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)