Provider Demographics
NPI:1962879650
Name:LOUISSAINT, ISABELLA (MSED)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:LOUISSAINT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22135 90TH AVE
Mailing Address - Street 2:APT 2C
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1324
Mailing Address - Country:US
Mailing Address - Phone:347-644-3370
Mailing Address - Fax:
Practice Address - Street 1:22135 90TH AVE
Practice Address - Street 2:APT 2C
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1324
Practice Address - Country:US
Practice Address - Phone:347-644-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist