Provider Demographics
NPI:1346593639
Name:LESBIA BETANCOURT
Entity Type:Organization
Organization Name:LESBIA BETANCOURT
Other - Org Name:SOLE PROPIERTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORK/CLINICIAN
Authorized Official - Prefix:MS
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:COUNTRY CLUB
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:COUNTRY CLUB
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:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3906261QM0801X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No302F00000XManaged Care OrganizationsExclusive Provider Organization