Provider Demographics
NPI:1184713299
Name:ACKERMAN, JOSEPH R (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 S CURSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4621
Mailing Address - Country:US
Mailing Address - Phone:323-424-4770
Mailing Address - Fax:
Practice Address - Street 1:1625 SCHRADER BLVD
Practice Address - Street 2:L.A. GAY AND LESBIAN CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6213
Practice Address - Country:US
Practice Address - Phone:323-993-7571
Practice Address - Fax:323-308-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0703111041C0700X
CA280201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical