Provider Demographics
NPI:1356588263
Name:BETTENCOURT, DARLENE MARIE
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:MARIE
Last Name:BETTENCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1544
Mailing Address - Country:US
Mailing Address - Phone:508-728-8344
Mailing Address - Fax:
Practice Address - Street 1:175 WHITE ST
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1544
Practice Address - Country:US
Practice Address - Phone:508-728-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS19476234390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program