MEDICARE: ANITA LYN ACEVEDO LCSW

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	1041C0700X	Clinical Social Worker	124828	MA
2	1041C0700X	Clinical Social Worker	13385	SC
3	1041C0700X	Clinical Social Worker	120308	CA
4	1041C0700X	Clinical Social Worker	007203	GA
5	1041C0700X	Clinical Social Worker	992150	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1041CO700X	OTHER	CO	VETERAN'S AFFAIRS

General Provider Information

NPI Number	:	1447572508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA LYN ACEVEDO LCSW

Provider Business Mailing Address
First Line	:	301 MONTECITO AVE
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1404
Country	:	US
Telephone Number	:	850-883-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 MONTECITO AVE
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1404
Country	:	US
Telephone Number	:	415-686-4379
Fax Number	:

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

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	12/21/2025

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Directions to “ ANITA LYN ACEVEDO LCSW” Practice Location

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