Provider Demographics
NPI:1164780664
Name:BETANCES, CRISTINA NOEL (LCSW)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:NOEL
Last Name:BETANCES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:NOEL
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6120 W SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4109
Mailing Address - Country:US
Mailing Address - Phone:773-255-5481
Mailing Address - Fax:
Practice Address - Street 1:4710 LINCOLN HWY
Practice Address - Street 2:#321
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2316
Practice Address - Country:US
Practice Address - Phone:773-420-3481
Practice Address - Fax:773-420-3597
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0077001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical