Provider Demographics
NPI:1164403341
Name:ACKERMAN, JENNIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 72ND ST
Mailing Address - Street 2:35 M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4537
Mailing Address - Country:US
Mailing Address - Phone:212-472-7854
Mailing Address - Fax:
Practice Address - Street 1:200 E 72ND ST
Practice Address - Street 2:35 M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4537
Practice Address - Country:US
Practice Address - Phone:212-472-7854
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034206R104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N10091Medicare ID - Type Unspecified