Healthcare Provider Details

I. General information

NPI: 1639771090
Provider Name (Legal Business Name): AVRAM ALTMAN LCSW, RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SULLIVAN TRL STE 7-323
EASTON PA
18040-8333
US

IV. Provider business mailing address

1700 SULLIVAN TRL STE 7-323
EASTON PA
18040-8333
US

V. Phone/Fax

Practice location:
  • Phone: 347-840-1462
  • Fax:
Mailing address:
  • Phone: 347-765-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW141953
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07091300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123109
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-22136
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number58.017083
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012983
License Number StateDE
# 7
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32363
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number010678
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86006908
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: