Healthcare Provider Details

I. General information

NPI: 1275954703
Provider Name (Legal Business Name): ANGELISE ACEBO MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 E. 149TH STREET 2ND FLOOR
BRONX NY
10455
US

IV. Provider business mailing address

358 E. 149TH STREET 2ND FLOOR
BRONX NY
10455
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax:
Mailing address:
  • Phone: 718-485-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: