Provider Demographics
NPI:1699803585
Name:CONNIE ISEMAN, LCSW, CAP, PA
Entity type:Organization
Organization Name:CONNIE ISEMAN, LCSW, CAP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:(MARY )
Authorized Official - Middle Name:CONNIE
Authorized Official - Last Name:ISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-339-2279
Mailing Address - Street 1:PO BOX 180957
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32718-0957
Mailing Address - Country:US
Mailing Address - Phone:407-339-2279
Mailing Address - Fax:407-830-4548
Practice Address - Street 1:1375 S SEMORAN BLVD
Practice Address - Street 2:SUITE 1305
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5529
Practice Address - Country:US
Practice Address - Phone:407-339-2279
Practice Address - Fax:407-830-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 35131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty