Provider Demographics
NPI:1407230063
Name:BETANCOURT, JANYSE (PHL)
Entity Type:Individual
Prefix:
First Name:JANYSE
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CALLE 6
Mailing Address - Street 2:SAINT JUST
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00978
Mailing Address - Country:US
Mailing Address - Phone:787-633-6933
Mailing Address - Fax:
Practice Address - Street 1:222 CALLE 6
Practice Address - Street 2:SAINT JUST
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00978
Practice Address - Country:US
Practice Address - Phone:787-633-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist