=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952504839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHANY ROSE CONNORS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 11/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 JUMONVILLE RD
-----------------------------------------------------
City | HOPWOOD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15445-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-438-5281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 JUMONVILLE RD
-----------------------------------------------------
City | HOPWOOD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15445-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-438-5281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW016662
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------