Provider Demographics
NPI:1942923628
Name:ACEVEDO, AMANDA SHANIELLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:SHANIELLE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3106
Mailing Address - Country:US
Mailing Address - Phone:631-398-3122
Mailing Address - Fax:
Practice Address - Street 1:1777 VETERANS MEMORIAL HWY STE 14
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1555
Practice Address - Country:US
Practice Address - Phone:631-212-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097228104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker