Provider Demographics
NPI:1821531021
Name:BETANCOURTH, MARIA (LAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BETANCOURTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 NORTH AVE W
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-5117
Mailing Address - Country:US
Mailing Address - Phone:908-433-9380
Mailing Address - Fax:
Practice Address - Street 1:118 NORTH AVE W
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-5117
Practice Address - Country:US
Practice Address - Phone:908-433-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00117400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist