Healthcare Provider Details

I. General information

NPI: 1265966428
Provider Name (Legal Business Name): GREGORY MARC ACKERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 DOGWOOD LN
BUSHKILL PA
18324-6848
US

IV. Provider business mailing address

380 MOUNT PROSPECT AVE APT 6F
NEWARK NJ
07104-2139
US

V. Phone/Fax

Practice location:
  • Phone: 973-558-2648
  • Fax:
Mailing address:
  • Phone: 973-558-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05905600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024635
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: