Healthcare Provider Details

I. General information

NPI: 1407843600
Provider Name (Legal Business Name): MARIA M ACEVEDO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 AVE ITURREGUI COUNTRY CLUB
SAN JUAN PR
00924-1723
US

IV. Provider business mailing address

CHALETS DEL PARQUE #153 PARQUE DE LO NINOS 12
GUAYNABO PR
00969-5501
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-0390
  • Fax: 787-768-1775
Mailing address:
  • Phone: 787-789-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1246
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: