Provider Demographics
NPI:1013470632
Name:BETANCOURT, MARISSA (MSCP, LPC, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:MSCP, LPC, CAADC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 REGINA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15209-1514
Mailing Address - Country:US
Mailing Address - Phone:412-334-8348
Mailing Address - Fax:
Practice Address - Street 1:37 MCMURRAY RD STE 204
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1632
Practice Address - Country:US
Practice Address - Phone:412-439-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14443405OtherCAQH
PA1308OtherCAADC
6535041OtherACA
PAPC011255OtherLPC
PA0678095246OtherCNA