Provider Demographics
NPI:1639771090
Name:ALTMAN, AVRAM (LMSW, RD, CDN)
Entity type:Individual
Prefix:
First Name:AVRAM
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:LMSW, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W 28TH ST APT 21B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7919
Mailing Address - Country:US
Mailing Address - Phone:347-840-1462
Mailing Address - Fax:
Practice Address - Street 1:365 W 28TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7901
Practice Address - Country:US
Practice Address - Phone:347-840-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-22136104100000X
CTMSW.010216104100000X
NJ44SL07091300104100000X
PASW141953104100000X
NY010678133V00000X
86006908133V00000X
NY123109104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered