Provider Demographics
NPI:1982452314
Name:ACEVEDO, EMELY ANDREA
Entity Type:Individual
Prefix:
First Name:EMELY
Middle Name:ANDREA
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 1:20335 W COUNTRY CLUB DR APT 1410
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1622
Mailing Address - Country:US
Mailing Address - Phone:786-523-9153
Mailing Address - Fax:
Practice Address - Street 1:20335 W COUNTRY CLUB DR APT 1410
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1622
Practice Address - Country:US
Practice Address - Phone:786-523-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-46227103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst