Provider Demographics
NPI:1922553478
Name:BETANCOURT, SANDRA O (PHD, CAP ICADC,CMHP)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:O
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:PHD, CAP ICADC,CMHP
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:O
Other - Last Name:BETANCOURT ISALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD,CAP,CHMP,ICADC
Mailing Address - Street 1:201 N FEDERAL HWY FL 2D
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3625
Mailing Address - Country:US
Mailing Address - Phone:561-807-9583
Mailing Address - Fax:954-422-1950
Practice Address - Street 1:201 N FEDERAL HWY FL 2D
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3625
Practice Address - Country:US
Practice Address - Phone:561-807-9583
Practice Address - Fax:954-422-1950
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4610101YA0400X
FL50150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health