Provider Demographics
NPI:1740910082
Name:ACEVEDO, AIDA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:MICHELLE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 LOFFLER CIR SE APT 107
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-2238
Mailing Address - Country:US
Mailing Address - Phone:321-917-0211
Mailing Address - Fax:
Practice Address - Street 1:660 LOFFLER CIR SE APT 107
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-2238
Practice Address - Country:US
Practice Address - Phone:321-907-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty