Provider Demographics
NPI:1568609261
Name:ACKERMAN, DAMON LEE (MA)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:LEE
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 MOOLU CIR
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-3317
Mailing Address - Country:US
Mailing Address - Phone:808-347-8537
Mailing Address - Fax:
Practice Address - Street 1:270 HOOKAHI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1466
Practice Address - Country:US
Practice Address - Phone:808-843-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health