Provider Demographics
NPI:1669144861
Name:ACEVEDO, MARI-LENA (MSW)
Entity type:Individual
Prefix:
First Name:MARI-LENA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BRADY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-1350
Mailing Address - Country:US
Mailing Address - Phone:917-716-4699
Mailing Address - Fax:
Practice Address - Street 1:80 WILLOWBROOK CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2402
Practice Address - Country:US
Practice Address - Phone:718-981-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1130739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker