MEDICARE: AEVUM BH VA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	1041C0700X	Clinical Social Worker
4	101YM0800X	Mental Health Counselor
5	106H00000X	Marriage & Family Therapist
6	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1225856008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEVUM BH VA LLC

Provider Business Mailing Address
First Line	:	440 SYLVAN AVE STE 240
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2700
Country	:	US
Telephone Number	:	804-446-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	4403 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3241
Country	:	US
Telephone Number	:	848-210-0028
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LEVI LIPOVENKO
Credential	:	PSYD
Telephone Number	:	804-446-1710

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	01/29/2026

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