Provider Demographics
NPI:1134180136
Name:ACEVEDO, VANESSA BLACKWOOD (LCSW)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:BLACKWOOD
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BROADLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4617
Mailing Address - Country:US
Mailing Address - Phone:718-459-1225
Mailing Address - Fax:
Practice Address - Street 1:9520 63RD RD
Practice Address - Street 2:SUITE J 2ND FLOOR
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1145
Practice Address - Country:US
Practice Address - Phone:718-459-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0732111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical