Provider Demographics
NPI:1992569677
Name:ASENCIO, JOEL CLEVELAND (MA, RCMHI)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:CLEVELAND
Last Name:ASENCIO
Suffix:
Gender:M
Credentials:MA, RCMHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11912 BALM RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6601
Mailing Address - Country:US
Mailing Address - Phone:813-444-7116
Mailing Address - Fax:
Practice Address - Street 1:29160 CHAPEL PARK DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-4404
Practice Address - Country:US
Practice Address - Phone:813-444-7116
Practice Address - Fax:813-537-8580
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health