MEDICARE: KATHLEEN ACEVEDO LMHC, MED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH18200	FL
2	101YM0800X	Mental Health Counselor	MH20554	FL

General Provider Information

NPI Number	:	1407388499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ACEVEDO LMHC, MED

Provider Business Mailing Address
First Line	:	1803 PARK CENTER DR STE 101
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6216
Country	:	US
Telephone Number	:	321-328-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 AVALON PARK EAST BLVD STE 301
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-9372
Country	:	US
Telephone Number	:	321-351-4925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	10/08/2024

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