Provider Demographics
NPI:1083884357
Name:BETANCOURT, DESIREE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:M
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DESIREE
Other - Middle Name:M
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-0364
Mailing Address - Country:US
Mailing Address - Phone:787-391-5660
Mailing Address - Fax:787-293-2700
Practice Address - Street 1:305 CALLE LA CRUZ
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-5941
Practice Address - Country:US
Practice Address - Phone:787-293-2700
Practice Address - Fax:787-293-2700
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical