Provider Demographics
NPI:1346821857
Name:BETANCOURT, MARIA ESTEFANIA (LSMW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ESTEFANIA
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:LSMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HUGUENOT ST APT 909
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6395
Mailing Address - Country:US
Mailing Address - Phone:551-274-1038
Mailing Address - Fax:
Practice Address - Street 1:3060 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5726
Practice Address - Country:US
Practice Address - Phone:718-239-1790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112208-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker