Provider Demographics
NPI:1538358957
Name:ISEMAN, MARY CONNIE (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CONNIE
Last Name:ISEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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:407-898-2990
Mailing Address - Fax:407-830-4548
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 3-A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-898-2990
Practice Address - Fax:407-830-4548
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 35131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8467Medicare PIN