Provider Demographics
NPI:1609492131
Name:ACEVEDO, JASMIN (LCSW)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:
Other - Last Name:ACEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 PILGRIM CT # 2
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3835
Mailing Address - Country:US
Mailing Address - Phone:908-344-2861
Mailing Address - Fax:
Practice Address - Street 1:17 PILGRIM CT # 2
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3835
Practice Address - Country:US
Practice Address - Phone:908-344-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-20
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NJ44SC057705001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker