Provider Demographics
NPI:1255868030
Name:LESBIA BETANCOURT
Entity Type:Organization
Organization Name:LESBIA BETANCOURT
Other - Org Name:LESBIA BETANCOURT, SOCIAL WORK SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:LESBIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:787-963-0171
Mailing Address - Street 1:911 CALLE LABRADOR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-1764
Mailing Address - Country:US
Mailing Address - Phone:787-963-0171
Mailing Address - Fax:
Practice Address - Street 1:911 CALLE LABRADOR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-1764
Practice Address - Country:US
Practice Address - Phone:787-963-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3906251K00000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1982847471Medicaid