Provider Demographics
NPI:1962242149
Name:ACEVEDO, SARA ALEJANDRA (LMSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ALEJANDRA
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 MENCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6746
Mailing Address - Country:US
Mailing Address - Phone:512-982-4116
Mailing Address - Fax:512-265-9008
Practice Address - Street 1:4022 MENCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6746
Practice Address - Country:US
Practice Address - Phone:512-982-4116
Practice Address - Fax:512-265-9008
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103897104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker