Healthcare Provider Details

I. General information

NPI: 1679799167
Provider Name (Legal Business Name): BERENICE D. ACEVEDO ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 BLACK CHERRY ST
SAN JACINTO CA
92582-4787
US

IV. Provider business mailing address

83861 OZARK DR.
INDIO CA
92203
US

V. Phone/Fax

Practice location:
  • Phone: 951-266-9191
  • Fax:
Mailing address:
  • Phone: 760-399-7097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW131042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: