Provider Demographics
NPI:1861570178
Name:COPPOLA-RIOS, BETHEA (MA)
Entity type:Individual
Prefix:
First Name:BETHEA
Middle Name:
Last Name:COPPOLA-RIOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 DURHAM AVE
Mailing Address - Street 2:BLDG. #6, SUITE 2A
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2546
Mailing Address - Country:US
Mailing Address - Phone:908-548-8533
Mailing Address - Fax:908-548-8532
Practice Address - Street 1:285 DURHAM AVE
Practice Address - Street 2:BLDG. #6, SUITE 2A
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2546
Practice Address - Country:US
Practice Address - Phone:908-548-8533
Practice Address - Fax:908-548-8532
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00339800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional