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General NPI Number Information
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NPI Number | 1699108936
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Entity Type | Individual
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Provider Name | MS. ERICA BEVILACQUA
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Gender | Female
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Dates
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Enumeration Date | 08/09/2013
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 2316 HISTORIC CIR
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City | MORRISVILLE
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State | NC
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Zip | 27560-8154
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Country | US
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Telephone | 202-609-8867
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Fax |
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Provider Business Mailing Address
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Address Line | 19 W 21ST ST SUITE 701
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City | NEW YORK
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State | NY
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Zip | 10010-6805
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Country | US
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Telephone | 646-230-8190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 10394
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License Number State | NC
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