Individual
CARLY BEVACQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6823 FARNSWORTH DR, PARMA, OH 44129-4514
(216) 644-2344
Mailing address
6823 FARNSWORTH DR, PARMA, OH 44129-4514
(216) 644-2344
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
175848
OH
374U00000X
Home Health Aide
—
OH
Other
Enumeration date
09/10/2020
Last updated
02/02/2021
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