Provider Demographics
NPI:1841350873
Name:ACKS, LAURIE NAN (MSW CSW)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:NAN
Last Name:ACKS
Suffix:
Gender:F
Credentials:MSW CSW
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:NAN
Other - Last Name:FRIEDLIEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:880 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:516-791-3902
Mailing Address - Fax:
Practice Address - Street 1:880 CHERRY LN
Practice Address - Street 2:
Practice Address - City:NORTH WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11581
Practice Address - Country:US
Practice Address - Phone:516-791-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0401961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01791928Medicaid
NYN1K331Medicare ID - Type Unspecified