Individual
MS. PATRICIA A BEVILACQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
32 GERDES RD, NEW CANAAN, CT 06840-6708
(914) 469-6243
Mailing address
240 CENTRAL AVE, WHITE PLAINS, NY 10606-1218
(914) 290-5797
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1275
CT
103TS0200X
School Psychologist
Primary
088722877
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275
LICENSE
CT
01
—
471725852
TAX ID
NY
Enumeration date
09/15/2015
Last updated
09/08/2021
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