Provider Demographics
NPI:1982847471
Name:BETANCOURT, LESBIA (MSW,MMHC)
Entity Type:Individual
Prefix:MS
First Name:LESBIA
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:MSW,MMHC
Other - Prefix:MS
Other - First Name:LESBIA
Other - Middle Name:
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, MMHC
Mailing Address - Street 1:2 BELDEN CT UNIT T-1
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3803
Mailing Address - Country:US
Mailing Address - Phone:413-737-3730
Mailing Address - Fax:413-737-1748
Practice Address - Street 1:20 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2902
Practice Address - Country:US
Practice Address - Phone:413-737-3730
Practice Address - Fax:413-737-1748
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3906302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization