Provider Demographics
NPI:1376222752
Name:ASENCIO, IVONNE M (PHD)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:M
Last Name:ASENCIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 PATRICIAN CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3293
Mailing Address - Country:US
Mailing Address - Phone:787-317-2673
Mailing Address - Fax:
Practice Address - Street 1:1101 MIRANDA LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0769
Practice Address - Country:US
Practice Address - Phone:407-494-3787
Practice Address - Fax:888-584-9071
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11826103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist