Ontaya Acedo, LMSW
Individual provider Active NPI Clinical Social Worker · Pocatello, ID
NPI 1104436062 · NPPES record last updated Mar 31, 2025
Key facts
- NPI
- 1104436062
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 8861355 (ID)
- Practice address
- 151 N 3Rd Ave Ste 330
Pocatello, ID 83201-6369 - Phone
- (208) 242-3771
- NPI assigned
- Aug 5, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gateway Counseling Incorporated
Practice addresses (Care Compare)
151 N 3Rd Ave
Suite 330
Pocatello, ID 83201-6369
Phone (208) 242-3771
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250127000526 | ID | Practitioner - Clinical Social Worker | 3870022411 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-39736 | ID | MD | Social Worker |
| 8861355 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Counseling Incorporated | Current |
Accepting new patients |
Locations
151 N 3rd Ave
Ste 330
Pocatello, ID 83201
Phone (208) 242-3771
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LMSW-39736 | ID | |
| Clinical Social Worker | 1041C0700X | 8861355 | ID | Yes |
Addresses
Primary practice location
151 N 3Rd Ave Ste 330
Pocatello, ID 83201-6369
Mailing address
151 N 3Rd Ave Ste 330
Pocatello, ID 83201-6369
Other providers in Pocatello, ID
- Gabrielle Abernathy
- Abiding Self Inc
- Lee Ann Roberts Abraszewski
- Nina Kellie Lateefee Abul-Husn
- Accessible Wellness
- Valeria Acevedo Caban
- Rishay Ackley
- Peter Chad Adamovich
- Alexandria D Adams
- Bryttnie Meagan Adams
All providers in Pocatello, ID · Clinical Social Worker in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.