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General NPI Number Information
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NPI Number | 1497305312
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Entity Type | Organization
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Legal Business Name | KRISTEN BETTENCOURT, PSYD, LLC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 126 PROSPECT ST STE 5
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City | CAMBRIDGE
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State | MA
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Zip | 02139-2500
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Country | US
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Telephone | 617-684-5153
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Fax | 844-208-1184
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Provider Business Mailing Address
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Address Line | 1 FARWELL ST
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City | NATICK
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State | MA
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Zip | 01760-5819
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Country | US
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Telephone | 617-803-7829
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | KRISTEN BETTENCOURT
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Credential | PSYD
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Telephone | 617-684-5153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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