Healthcare Provider Details

I. General information

NPI: 1629740725
Provider Name (Legal Business Name): NATALIA BETANCOURT GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MCCLELLAN HWY STE 105B
BOSTON MA
02128-1101
US

IV. Provider business mailing address

147 NORMAN ST
WEST SPRINGFIELD MA
01089-5003
US

V. Phone/Fax

Practice location:
  • Phone: 857-264-0965
  • Fax:
Mailing address:
  • Phone: 413-736-8329
  • Fax: 413-732-5362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04238
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: