Patricia A Bevilacqua, BCBA
Individual provider Active NPI School Psychologist · New Canaan, CT
NPI 1811366347 · NPPES record last updated Sep 8, 2021
Key facts
- NPI
- 1811366347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 088722877 (NY)
- Practice address
- 32 Gerdes Rd
New Canaan, CT 06840-6708 - Phone
- (914) 469-6243
- NPI assigned
- Sep 15, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1275 | CT | MD | Clinical Psychologist |
| 088722877 | NY | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Behavioral Solutions LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1275 | CT | |
| School Psychologist | 103TS0200X | 088722877 | NY | Yes |
Addresses
Primary practice location
32 Gerdes Rd
New Canaan, CT 06840-6708
Mailing address
240 Central Ave
White Plains, NY 10606-1218
Phone (914) 290-5797
Other practice location 1
240 Central Ave
White Plains, NY 10606-1218
Phone (914) 290-5797
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275 | Other | CT | LICENSE |
| 471725852 | Other | NY | TAX ID |
| 1275 | Other | CT | LICENSE NUMBER |
Other providers in New Canaan, CT
- Catherine Leigh Beeson
- Kathleen Mary Berchelmann
- Meredith Bergman
- Benjamin Bernstein
- Kenneth R Berv
- Alison Birnbaum
- Robert Francis Bottone
- Jason Bracich
- Rachel Anne Branzer
- Adam Brodsky
All providers in New Canaan, CT · School Psychologist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.