Provider Demographics
NPI:1609930411
Name:ACKERMAN, REBEKAH ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:ANN
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 1:254 TREE RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2344
Mailing Address - Country:US
Mailing Address - Phone:631-467-5157
Mailing Address - Fax:631-467-5157
Practice Address - Street 1:254 TREE RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2344
Practice Address - Country:US
Practice Address - Phone:631-467-5157
Practice Address - Fax:631-467-5157
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR014914-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical