Provider Demographics
NPI:1982289732
Name:BETANCOURT, JORGE ARMANDO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ARMANDO
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14919 SW 80TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3151
Mailing Address - Country:US
Mailing Address - Phone:305-877-6383
Mailing Address - Fax:
Practice Address - Street 1:14919 SW 80TH ST APT 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3151
Practice Address - Country:US
Practice Address - Phone:305-877-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-118422106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician