Provider Demographics
NPI:1104203355
Name:BETANCOURT, MEGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 W BROWARD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1018
Mailing Address - Country:US
Mailing Address - Phone:954-587-1008
Mailing Address - Fax:
Practice Address - Street 1:3800 W BROWARD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1018
Practice Address - Country:US
Practice Address - Phone:954-587-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW122601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical