Healthcare Provider Details

I. General information

NPI: 1518650266
Provider Name (Legal Business Name): EMILY ACKOUREY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 MONROE AVE
DUNMORE PA
18509-2477
US

IV. Provider business mailing address

437 JESSUP ST
DUNMORE PA
18512-2010
US

V. Phone/Fax

Practice location:
  • Phone: 973-902-6202
  • Fax:
Mailing address:
  • Phone: 973-902-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136980
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: