Healthcare Provider Details

I. General information

NPI: 1164403341
Provider Name (Legal Business Name): JENNIE ACKERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 72ND ST 35 M
NEW YORK NY
10021-4537
US

IV. Provider business mailing address

200 E 72ND ST 35 M
NEW YORK NY
10021-4537
US

V. Phone/Fax

Practice location:
  • Phone: 212-472-7854
  • Fax:
Mailing address:
  • Phone: 212-472-7854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number034206R
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: