Provider Demographics
NPI:1114073780
Name:BEVILACQUA, RACHELLE L (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:L
Last Name:BEVILACQUA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:SCHWENKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19473-2203
Mailing Address - Country:US
Mailing Address - Phone:215-500-0397
Mailing Address - Fax:
Practice Address - Street 1:555 2ND AVE
Practice Address - Street 2:BLDG B., SUITE 350
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3600
Practice Address - Country:US
Practice Address - Phone:215-500-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional