Provider Demographics
NPI:1932308400
Name:BETANCOURT, INES TERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:INES
Middle Name:TERESA
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 1:1525 SILVER AVENUE, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134
Mailing Address - Country:US
Mailing Address - Phone:415-337-8281
Mailing Address - Fax:415-657-1774
Practice Address - Street 1:1525 SILVER AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-1229
Practice Address - Country:US
Practice Address - Phone:415-657-1795
Practice Address - Fax:415-657-1774
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS163481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6010OtherSFGH INTERNAL USE ONLY