Provider Demographics
NPI:1912384942
Name:BETHEA-MILLER, VANESSA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BETHEA-MILLER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 THORNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-2216
Mailing Address - Country:US
Mailing Address - Phone:609-433-7012
Mailing Address - Fax:
Practice Address - Street 1:133 GREENLAND AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-3627
Practice Address - Country:US
Practice Address - Phone:609-433-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health