Provider Demographics
NPI:1639568132
Name:BETANCOURT, LIZ M (PHD)
Entity Type:Individual
Prefix:
First Name:LIZ
Middle Name:M
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:M
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:PO BOX 1633
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1633
Mailing Address - Country:US
Mailing Address - Phone:787-249-1353
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:TORRE MEDICA DE AUXLIO MUTUO SUITE 203
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-249-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4077103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist