Provider Demographics
NPI:1215673827
Name:ACEVEDO, KEISHLA (MSW)
Entity type:Individual
Prefix:
First Name:KEISHLA
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 1:60 AVE WINSTON CHURCHILL APT 2106
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6715
Mailing Address - Country:US
Mailing Address - Phone:787-510-9395
Mailing Address - Fax:
Practice Address - Street 1:60 AVE WINSTON CHURCHILL APT 2106
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6715
Practice Address - Country:US
Practice Address - Phone:787-510-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR154701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5001575OtherDRIVER LICENSE