Provider Demographics
NPI:1558577122
Name:LORD, CARMEN BETANCOURT (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:BETANCOURT
Last Name:LORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 MADRUGA AVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3040
Mailing Address - Country:US
Mailing Address - Phone:305-661-0855
Mailing Address - Fax:
Practice Address - Street 1:1570 MADRUGA AVE
Practice Address - Street 2:SUITE 219
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3040
Practice Address - Country:US
Practice Address - Phone:305-661-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0000771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist