Provider Demographics
NPI:1255733762
Name:ACEVEDO, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E 116TH ST
Mailing Address - Street 2:#309
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1128
Mailing Address - Country:US
Mailing Address - Phone:636-359-6479
Mailing Address - Fax:
Practice Address - Street 1:80 E 116TH ST
Practice Address - Street 2:#309
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1128
Practice Address - Country:US
Practice Address - Phone:636-359-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084966-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker