Provider Demographics
NPI:1679976955
Name:ACEVEDO, AMY (LMSW, LSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:LMSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2901
Mailing Address - Country:US
Mailing Address - Phone:201-563-2442
Mailing Address - Fax:
Practice Address - Street 1:751 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2901
Practice Address - Country:US
Practice Address - Phone:201-563-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091678-1104100000X
NJ44SL05940900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker