Provider Demographics
NPI:1578728291
Name:ACEVEDO, SANDRA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:ACEVEDO
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:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1037
Mailing Address - Country:US
Mailing Address - Phone:787-431-6006
Mailing Address - Fax:787-868-0485
Practice Address - Street 1:1052 BO ASOMANTE
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3142
Practice Address - Country:US
Practice Address - Phone:787-431-6006
Practice Address - Fax:787-868-0485
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2378103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling