Provider Demographics
NPI:1639426364
Name:ROCHA, BETHANY J
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:J
Last Name:ROCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MONROE AVE NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2212
Mailing Address - Country:US
Mailing Address - Phone:800-600-4096
Mailing Address - Fax:800-606-8839
Practice Address - Street 1:201 MONROE AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2212
Practice Address - Country:US
Practice Address - Phone:800-600-4096
Practice Address - Fax:800-606-8839
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2295186104100000X
MI6801094709104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker