Provider Demographics
NPI:1538233473
Name:ISENBERG, MARTIN M (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:M
Last Name:ISENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6247 BROOKSIDE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1645
Mailing Address - Country:US
Mailing Address - Phone:816-361-2244
Mailing Address - Fax:816-361-2244
Practice Address - Street 1:6247 BROOKSIDE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-1645
Practice Address - Country:US
Practice Address - Phone:816-361-2244
Practice Address - Fax:816-361-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY00923103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0007427Medicare ID - Type Unspecified