Individual
LOUIS BEVILACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1440 RUSSELL RD, PAOLI, PA 19301-1236
(610) 644-6464
Mailing address
1440 RUSSELL RD, PAOLI, PA 19301-1236
(610) 644-6464
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS015441
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2080814000
IBC
PA
01
—
7458472
AETNA
PA
Enumeration date
09/03/2006
Last updated
07/08/2007
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