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Individual

EDWARD BEVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSY. D.

Contact information

Practice address
1056 ROUTE 390, MOUNTAINHOME, PA 18342
(570) 807-6638
Mailing address
3287 SPRUCE CABIN RD, CRESCO, PA 18326-7916
(570) 807-6638

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
PS017344
PA
103TC0700X
Clinical Psychologist
PS017344
PA
103TP2701X
Group Psychotherapy Psychologist
PS017344
PA

Other

Enumeration date
08/19/2015
Last updated
08/19/2015
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