Healthcare Provider Details

I. General information

NPI: 1811049463
Provider Name (Legal Business Name): ONEIDA ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 N DYSART RD
LITCHFIELD PARK AZ
85340-3045
US

IV. Provider business mailing address

5220 N DYSART RD STE 172
LITCHFIELD PARK AZ
85340-3049
US

V. Phone/Fax

Practice location:
  • Phone: 602-487-1174
  • Fax:
Mailing address:
  • Phone: 412-598-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number499
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: