MEDICARE: DEBRA BETH ACKERMAN LMSW, EDM

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	104100000X	Social Worker	075381	NY

General Provider Information

NPI Number	:	1629394796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA BETH ACKERMAN LMSW, EDM

Provider Business Mailing Address
First Line	:	680 FORT WASHINGTON AVE
Second Line	:	APT 5E
City	:	NEW YORK
State	:	NY
Zip	:	10040-3913
Country	:	US
Telephone Number	:	973-464-0093
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 FORT WASHINGTON AVE
Second Line	:	APT 5E
City	:	NEW YORK
State	:	NY
Zip	:	10040-3913
Country	:	US
Telephone Number	:	973-464-0093
Fax Number	:

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

Provider Enumeration Date	:	04/14/2010
Last Update Date	:	04/14/2010

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