Provider Demographics
NPI:1407365851
Name:ACKERMAN, LISA DIANE (BSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:DIANE
Other - Last Name:CSIZMADIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:608 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1617
Mailing Address - Country:US
Mailing Address - Phone:989-466-4130
Mailing Address - Fax:
Practice Address - Street 1:608 WRIGHT AVE.
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801
Practice Address - Country:US
Practice Address - Phone:989-466-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088923104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker