Provider Demographics
NPI:1275845224
Name:ACEVEDO-MASSA, JOSEPHINE (MSW)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:ACEVEDO-MASSA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15225 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1802
Mailing Address - Country:US
Mailing Address - Phone:954-625-5850
Mailing Address - Fax:
Practice Address - Street 1:10001 W OAKLAND PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6925
Practice Address - Country:US
Practice Address - Phone:954-746-5200
Practice Address - Fax:954-746-5216
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW10191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL421140Medicare UPIN