Carly Bevacqua

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

175848 Issued in OH

Practice address

6823 Farnsworth Dr
Parma, OH 44129-4514

Phone

(216) 644-2344

NPI assigned

Sep 10, 2020

Last updated

Feb 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1821603325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6823 FARNSWORTH DR",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441294514",
            "telephone_number": "216-644-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6823 FARNSWORTH DR",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441294514",
            "telephone_number": "216-644-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEVACQUA",
        "first_name": "CARLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-10",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "175848",
            "primary": true
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "OH",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Bertolone, PHARMD
• Valdis Berzins, DMD
• Heather Bess, LISW
• Tesharra S Bethly
• Stephanie Louise Betz, R.N.
• Karen Beyer
• Timmappa Pandappa Bidari, M.D.
• Sara Biedenbach, RN
• Kelly Ann Bier, NP
• Birchcrest Holdings, LLC (Pdi Parma)

• Addiction (Substance Use Disorder) Counselor in Parma, OH
• Providers in Parma, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.