Healthcare Provider Details

I. General information

NPI: 1942518188
Provider Name (Legal Business Name): NELI MARIA ACEVEDO MSW STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 3RD AVE
NEW YORK NY
10029-2184
US

IV. Provider business mailing address

91 FORT WASHINGTON AVE APT 22
NEW YORK NY
10032-4638
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-6144
  • Fax:
Mailing address:
  • Phone: 212-568-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number545163270
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: