Provider Demographics
NPI:1124555412
Name:TIRADO ACEVEDO, LIZBETH (MASTER DEGREE)
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:TIRADO ACEVEDO
Suffix:
Gender:F
Credentials:MASTER DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 VILLA VERANO WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5997
Mailing Address - Country:US
Mailing Address - Phone:321-437-6356
Mailing Address - Fax:
Practice Address - Street 1:2244 VILLA VERANO WAY APT 301
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5997
Practice Address - Country:US
Practice Address - Phone:321-437-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health