Provider Demographics
NPI:1871531798
Name:VIRGINIA D. MAC ISAAC, LCSW, LLC
Entity type:Organization
Organization Name:VIRGINIA D. MAC ISAAC, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAC ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-444-3533
Mailing Address - Street 1:615 BLUE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3417
Mailing Address - Country:US
Mailing Address - Phone:201-444-3533
Mailing Address - Fax:
Practice Address - Street 1:323 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1501
Practice Address - Country:US
Practice Address - Phone:201-444-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051722001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077704Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER