Provider Demographics
NPI:1447589726
Name:BETANCOURT, ANTONIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 GREENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4317
Mailing Address - Country:US
Mailing Address - Phone:610-853-6233
Mailing Address - Fax:
Practice Address - Street 1:434 GREENVIEW LN
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4317
Practice Address - Country:US
Practice Address - Phone:610-853-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0153001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical