Individual
LEAH BEVILACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
522 PASEO PUEBLO NORTE, UNIT D, TAOS, NM 87571
(575) 252-4766
Mailing address
PO BOX 11, EL PRADO, NM 87529-0011
(575) 751-7552
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
01/13/2014
Last updated
07/12/2024
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