Provider Demographics
NPI:1558251744
Name:ACEVEDO, PEDRO J
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 864 CALLE LA PLUMA HATO TEJAS
Mailing Address - Street 2:205
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-473-3410
Mailing Address - Fax:
Practice Address - Street 1:CALLE PAJAROS BARIADA CEDENO
Practice Address - Street 2:17
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-4256
Practice Address - Country:US
Practice Address - Phone:787-473-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3747101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)