Provider Demographics
NPI:1265568802
Name:ACEVEDO, GLADYS (PHD)
Entity type:Individual
Prefix:DR
First Name:GLADYS
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 1:6400 SAUNDERS STREET
Mailing Address - Street 2:APT 1E
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3120
Mailing Address - Country:US
Mailing Address - Phone:718-897-5095
Mailing Address - Fax:
Practice Address - Street 1:34 24 KOSSUTH AVENUE 4B
Practice Address - Street 2:NORTH CENTRAL BRONX HOSP AOPD
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-519-3440
Practice Address - Fax:718-519-2497
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0146981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical