Provider Demographics
NPI:1578945572
Name:BETANCOURT, ERIC CARMEN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CARMEN
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2331
Mailing Address - Country:US
Mailing Address - Phone:602-257-9339
Mailing Address - Fax:602-265-8533
Practice Address - Street 1:1424 S 7TH AVE
Practice Address - Street 2:BUILDING B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3902
Practice Address - Country:US
Practice Address - Phone:602-257-8970
Practice Address - Fax:602-265-8533
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7918363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health