Provider Demographics
NPI:1821542143
Name:BETANCOURT, TATIANA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:MARIE
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502703
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-2703
Mailing Address - Country:US
Mailing Address - Phone:619-525-9903
Mailing Address - Fax:
Practice Address - Street 1:13133 GLEN CIRCLE RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2039
Practice Address - Country:US
Practice Address - Phone:858-215-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical