Provider Demographics
NPI:1992443691
Name:ACKERMAN, SERENA ISIDORA (CSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:ISIDORA
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:CSW, LCSW
Other - Prefix:MRS
Other - First Name:SERENA
Other - Middle Name:ISIDORA
Other - Last Name:DAMSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW, LCSW
Mailing Address - Street 1:175 E RIDGELINE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-3001
Mailing Address - Country:US
Mailing Address - Phone:801-809-4911
Mailing Address - Fax:
Practice Address - Street 1:175 E RIDGELINE WAY
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-3001
Practice Address - Country:US
Practice Address - Phone:801-809-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12158508-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health