Provider Demographics
NPI:1508471210
Name:BETANCOURT VAZQUEZ, AMEIRYS
Entity Type:Individual
Prefix:
First Name:AMEIRYS
Middle Name:
Last Name:BETANCOURT VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 SW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4756
Mailing Address - Country:US
Mailing Address - Phone:786-399-4789
Mailing Address - Fax:
Practice Address - Street 1:2654 SW 32ND ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4756
Practice Address - Country:US
Practice Address - Phone:786-399-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty