Provider Demographics
NPI:1063677003
Name:ACEVEDO, MARCELA CECILIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:CECILIA
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 MILES RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-0000
Mailing Address - Country:US
Mailing Address - Phone:505-604-5889
Mailing Address - Fax:505-508-1278
Practice Address - Street 1:2418 MILES RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3224
Practice Address - Country:US
Practice Address - Phone:505-604-5889
Practice Address - Fax:505-508-1278
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0764103TB0200X, 103TC2200X, 103TF0000X
NM103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool