Provider Demographics
NPI:1255686614
Name:ACEVEDO, VERONICA CELIA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:CELIA
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SQUARE HILL RD
Mailing Address - Street 2:APT 31-1
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8403
Mailing Address - Country:US
Mailing Address - Phone:607-437-5869
Mailing Address - Fax:
Practice Address - Street 1:1124 ROUTE 94
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7258
Practice Address - Country:US
Practice Address - Phone:845-787-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084284-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY