Provider Demographics
NPI:1609274174
Name:BETANCOURT, ALICIA MARIE
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MARIE
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:OTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2653 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1936
Mailing Address - Country:US
Mailing Address - Phone:407-846-5220
Mailing Address - Fax:407-846-5225
Practice Address - Street 1:2653 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1936
Practice Address - Country:US
Practice Address - Phone:407-846-5220
Practice Address - Fax:407-846-5225
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker