MEDICARE: MRS. LAURIE NAN ACKS MSW CSW

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	R040196	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841350873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE NAN ACKS MSW CSW

Provider Business Mailing Address
First Line	:	880 CHERRY LN
Second Line	:
City	:	NORTH WOODMERE
State	:	NY
Zip	:	11581
Country	:	US
Telephone Number	:	516-791-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 CHERRY LN
Second Line	:
City	:	NORTH WOODMERE
State	:	NY
Zip	:	11581
Country	:	US
Telephone Number	:	516-791-3902
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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