Provider Demographics
NPI:1528176757
Name:ISAACS, MARJORIE (PSY D)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:ISAACS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2437
Mailing Address - Country:US
Mailing Address - Phone:513-631-5363
Mailing Address - Fax:513-631-3925
Practice Address - Street 1:3315 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2437
Practice Address - Country:US
Practice Address - Phone:513-631-5363
Practice Address - Fax:513-631-3925
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4153103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0923979Medicaid
OH0923979Medicaid