Active NPI
Laura Bevilacqua, MFTI
- Marriage & Family Therapist
- Brentwood, CA
National Provider Identifier
1295273019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 74986
- Practice address
- 160 Guthrie LN # B
Suite 1
Brentwood, CA 94513-4059 - Phone
- (925) 222-9657
- NPI assigned
- Feb 1, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 74986 | CA | Primary |
Addresses
Primary practice location
160 Guthrie LN # B
Suite 1
Brentwood, CA 94513-4059
Mailing address
160 Guthrie LN # B
Suite 1
Brentwood, CA 94513-4059
Phone (925) 222-9657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74986 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Balance Institute of Healing | Marriage & Family Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Marriage & Family Therapist
- Placerville, CA
- NPI 1033625462
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485907200000",
"number": "1295273019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 GUTHRIE LN # B",
"address_2": "SUITE 1",
"city": "BRENTWOOD",
"state": "CA",
"postal_code": "945134059",
"telephone_number": "925-222-9657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 GUTHRIE LN # B",
"address_2": "SUITE 1",
"city": "BRENTWOOD",
"state": "CA",
"postal_code": "945134059",
"telephone_number": "925-222-9657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEVILACQUA",
"first_name": "LAURA",
"credential": "MFTI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-01",
"last_updated": "2017-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "74986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.