Provider Demographics
NPI:1174576995
Name:ACEVEDO, HECTOR M (LCSW)
Entity type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:M
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:HECTOR
Other - Middle Name:M
Other - Last Name:ACEVEDO-ROSADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:717 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4580
Mailing Address - Country:US
Mailing Address - Phone:407-846-0533
Mailing Address - Fax:407-518-1730
Practice Address - Street 1:717 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4580
Practice Address - Country:US
Practice Address - Phone:321-332-6984
Practice Address - Fax:407-685-3325
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 68511041C0700X
FLSW6851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ082YOtherBCBS
FLZ082YOtherBCBS