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General NPI Number Information
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NPI Number | 1265568802
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Entity Type | Individual
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Provider Name | GLADYS ACEVEDO PHD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 34 24 KOSSUTH AVENUE 4B NORTH CENTRAL BRONX HOSP AOPD
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City | BRONX
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State | NY
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Zip | 10467
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Country | US
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Telephone | 718-519-3440
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Fax | 718-519-2497
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Provider Business Mailing Address
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Address Line | 6400 SAUNDERS STREET APT 1E
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City | REGO PARK
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State | NY
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Zip | 11374-3120
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Country | US
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Telephone | 718-897-5095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0146981
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License Number State | NY
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