Healthcare Provider Details

I. General information

NPI: 1720952013
Provider Name (Legal Business Name): TATIANA TAYCH BETANCOURT RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C17 CALLE MARGINAL
BAYAMON PR
00961-6706
US

IV. Provider business mailing address

61 CALLE QUISQUEYA
SAN JUAN PR
00917-1202
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-1273
  • Fax:
Mailing address:
  • Phone: 787-250-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17197
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: