Provider Demographics
NPI:1073904975
Name:ACEVEDO, ALEXIS (LMHC, CASAC-M)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:LMHC, CASAC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 20TH ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-1254
Mailing Address - Country:US
Mailing Address - Phone:646-685-4422
Mailing Address - Fax:516-218-7964
Practice Address - Street 1:159 20TH ST STE 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1254
Practice Address - Country:US
Practice Address - Phone:646-685-4422
Practice Address - Fax:516-218-7964
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
133306195OtherACT
NY01764878Medicaid