MEDICARE: MRS. RITA G. ACKERMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R032660-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	145926	OTHER	NY	VALUE OPTIONS ID#
2	7401510	OTHER	NY	GHI PROVIDER #

General Provider Information

NPI Number	:	1366532624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA G. ACKERMAN LCSW

Provider Business Mailing Address
First Line	:	18215 RADNOR RD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-1537
Country	:	US
Telephone Number	:	718-969-5326
Fax Number	:	718-969-4122

Provider Business Practice Location Address
First Line	:	18215 RADNOR RD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-1537
Country	:	US
Telephone Number	:	718-969-5326
Fax Number	:	718-969-4122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	07/08/2007

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