Healthcare Provider Details

I. General information

NPI: 1003186776
Provider Name (Legal Business Name): MELITZA ACEVEDO-CHARLES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PARK AVE
YONKERS NY
10703-3402
US

IV. Provider business mailing address

265 N BROADWAY APT 1M
YONKERS NY
10701-2656
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-7845
  • Fax: 914-964-7321
Mailing address:
  • Phone: 914-513-8466
  • Fax: 914-964-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0137092
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084017
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: