Provider Demographics
NPI:1669982930
Name:BIVENS, BETHANY LORRAINE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LORRAINE
Last Name:BIVENS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N DUKE ST APT 55-106
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2064
Mailing Address - Country:US
Mailing Address - Phone:336-558-8203
Mailing Address - Fax:
Practice Address - Street 1:2608 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4596
Practice Address - Country:US
Practice Address - Phone:919-668-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical