Provider Demographics
NPI:1386425502
Name:BETECK, ROSE NDOA (PHD, LCSW-C)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:NDOA
Last Name:BETECK
Suffix:
Gender:F
Credentials:PHD, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9164 NEW BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2092
Mailing Address - Country:US
Mailing Address - Phone:410-603-9977
Mailing Address - Fax:
Practice Address - Street 1:9164 NEW BRIDGE DR
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:MD
Practice Address - Zip Code:21875-2092
Practice Address - Country:US
Practice Address - Phone:410-603-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD288431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical