Provider Demographics
NPI:1952929275
Name:ACKERMAN, SUSAN LYNN
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5120
Mailing Address - Country:US
Mailing Address - Phone:914-522-0452
Mailing Address - Fax:
Practice Address - Street 1:11 N HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5120
Practice Address - Country:US
Practice Address - Phone:914-522-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator