=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083884357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DESIREE M BETANCOURT VINCENTY PSY.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2008
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 871 LA TORRE BUILDING CARR 876 KM 2.3 URB. LOURDES
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-391-5660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 364
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00977-0364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-391-5660
-----------------------------------------------------
Fax | 787-293-2700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2940
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------