Provider Demographics
NPI:1902447683
Name:MARIA T ISAVA, LCSW PLLC
Entity Type:Organization
Organization Name:MARIA T ISAVA, LCSW PLLC
Other - Org Name:MARIA T ISAVA, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KONYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-702-8265
Mailing Address - Street 1:601 SHASTA CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7056
Mailing Address - Country:US
Mailing Address - Phone:469-469-9557
Mailing Address - Fax:
Practice Address - Street 1:4425 PLANO PKWY STE 701
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-5031
Practice Address - Country:US
Practice Address - Phone:469-469-9557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX445232491OtherBCBS TEXAS
TX67389OtherLICENSURE