Provider Demographics
NPI:1043801384
Name:ROSE, BETHANY (BCBA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 NEW HAMPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3803
Mailing Address - Country:US
Mailing Address - Phone:302-299-7169
Mailing Address - Fax:
Practice Address - Street 1:1126 NEW HAMPSHIRE LN
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3803
Practice Address - Country:US
Practice Address - Phone:302-299-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-20-43934103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst