Provider Demographics
NPI:1275217481
Name:BETANCOURTH, EILEEN ALEXANDRA
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:ALEXANDRA
Last Name:BETANCOURTH
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 1:306 TURNSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8475
Mailing Address - Country:US
Mailing Address - Phone:407-928-1460
Mailing Address - Fax:
Practice Address - Street 1:445 W AMELIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1129
Practice Address - Country:US
Practice Address - Phone:407-317-3200
Practice Address - Fax:407-317-3200
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist