Provider Demographics
NPI:1124526553
Name:ACKERMAN, IRIS SUZANNE (PHD, LCSW)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:SUZANNE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-2120
Mailing Address - Country:US
Mailing Address - Phone:516-374-6259
Mailing Address - Fax:
Practice Address - Street 1:38 WESLEY DR
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-2120
Practice Address - Country:US
Practice Address - Phone:516-374-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-037720-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker