Provider Demographics
NPI:1114625092
Name:BETANCOURT, JOSBERLY
Entity Type:Individual
Prefix:
First Name:JOSBERLY
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NW 109TH AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5255
Mailing Address - Country:US
Mailing Address - Phone:786-832-9929
Mailing Address - Fax:
Practice Address - Street 1:230 NW 109TH AVE APT 217
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5255
Practice Address - Country:US
Practice Address - Phone:786-832-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician