Provider Demographics
NPI:1124184270
Name:ACEVEDO, CARMEN J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:J
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 S PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4375
Mailing Address - Country:US
Mailing Address - Phone:321-313-0633
Mailing Address - Fax:
Practice Address - Street 1:1380 S PATRICK DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4375
Practice Address - Country:US
Practice Address - Phone:321-313-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00028181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical