Healthcare Provider Details

I. General information

NPI: 1427871987
Provider Name (Legal Business Name): BRIAN ACKERMAN, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 12TH ST STE 706
BROOKLYN NY
11249-1022
US

IV. Provider business mailing address

111 N 12TH ST STE 706
BROOKLYN NY
11249-1022
US

V. Phone/Fax

Practice location:
  • Phone: 914-313-8612
  • Fax:
Mailing address:
  • Phone: 727-642-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. BRIAN ACKERMAN
Title or Position: OWNER
Credential: LCSW
Phone: 727-642-7995