Healthcare Provider Details

I. General information

NPI: 1598622631
Provider Name (Legal Business Name): MS. INDIANA M ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ANA LENS DE SUSONI #22
ARECIBO PR
00612
US

IV. Provider business mailing address

URB. EL PLANTIO CALLE CAOBA D34
TOA BAJA PR
00949-4419
US

V. Phone/Fax

Practice location:
  • Phone: 787-879-1962
  • Fax:
Mailing address:
  • Phone: 787-238-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8622
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: