=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366532624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RITA G. ACKERMAN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18215 RADNOR RD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-1537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-969-5326
-----------------------------------------------------
Fax | 718-969-4122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18215 RADNOR RD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-1537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-969-5326
-----------------------------------------------------
Fax | 718-969-4122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R032660-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------