Provider Demographics
NPI:1497305312
Name:KRISTEN BETTENCOURT, PSYD, LLC
Entity Type:Organization
Organization Name:KRISTEN BETTENCOURT, PSYD, LLC
Other - Org Name:KRISTEN BETTENCOURT, PSYD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTENCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-684-5153
Mailing Address - Street 1:1 FARWELL ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-5819
Mailing Address - Country:US
Mailing Address - Phone:617-803-7829
Mailing Address - Fax:
Practice Address - Street 1:126 PROSPECT ST STE 5
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2500
Practice Address - Country:US
Practice Address - Phone:617-684-5153
Practice Address - Fax:844-208-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty