Healthcare Provider Details

I. General information

NPI: 1699797001
Provider Name (Legal Business Name): LAURIE J. ACKERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

3801 MIRANDA AVE. ATTN: 122
PALO ALTO CA
94304
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-493-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3302
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: