Healthcare Provider Details

I. General information

NPI: 1447572508
Provider Name (Legal Business Name): ANITA LYN ACEVEDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MONTECITO AVE
CORTE MADERA CA
94925-1404
US

IV. Provider business mailing address

301 MONTECITO AVE
CORTE MADERA CA
94925-1404
US

V. Phone/Fax

Practice location:
  • Phone: 415-686-4379
  • Fax:
Mailing address:
  • Phone: 850-883-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124828
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13385
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120308
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007203
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992150
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: