Provider Demographics
NPI:1225700636
Name:DE LA ROSA ACEVES, KATELYN MARIE (ASW)
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:MARIE
Last Name:DE LA ROSA ACEVES
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1382
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-1382
Mailing Address - Country:US
Mailing Address - Phone:626-434-5687
Mailing Address - Fax:
Practice Address - Street 1:1520 N RAYMOND AVE BLDG 2-7
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1819
Practice Address - Country:US
Practice Address - Phone:626-396-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAASW103335104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health