Provider Demographics
NPI:1366696833
Name:ACKMAN, PHYLLIS (PHD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:ACKMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:ACKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 WEST 96TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-663-6680
Mailing Address - Fax:212-316-5275
Practice Address - Street 1:12 WEST 96TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-663-6680
Practice Address - Fax:212-316-5275
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical