Provider Demographics
NPI:1629394796
Name:ACKERMAN, DEBRA BETH (LMSW, EDM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:BETH
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LMSW, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 FORT WASHINGTON AVE
Mailing Address - Street 2:APT 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3913
Mailing Address - Country:US
Mailing Address - Phone:973-464-0093
Mailing Address - Fax:
Practice Address - Street 1:680 FORT WASHINGTON AVE
Practice Address - Street 2:APT 5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3913
Practice Address - Country:US
Practice Address - Phone:973-464-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker