Provider Demographics
NPI:1215569439
Name:ACEVEDO, NANCY (MA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 QUEBEC RD
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-2301
Mailing Address - Country:US
Mailing Address - Phone:239-601-7180
Mailing Address - Fax:
Practice Address - Street 1:3049 CLEVELAND AVE STE 290
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7054
Practice Address - Country:US
Practice Address - Phone:239-689-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health