Organization
BEVILACQUA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEAH BEVILACQUA (OWNER)
(724) 244-4815
Entity
Organization
Contact information
Practice address
1518 PASEO DEL PUEBLO NORTE UNIT 11, EL PRADO, NM 87529-8004
(724) 244-4815
Mailing address
PO BOX 11, EL PRADO, NM 87529-0011
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/14/2024
Last updated
10/23/2024
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