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General NPI Number Information
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NPI Number | 1588323018
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Entity Type | Individual
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Provider Name | STEPHANIE BETANCOURT
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Gender | Female
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 3800 W BROWARD BLVD STE 100
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-1018
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Country | US
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Telephone | 954-587-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 2061 NW 84TH WAY
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City | SUNRISE
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State | FL
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Zip | 33322-3839
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH20037
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License Number State | FL
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