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General NPI Number Information
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NPI Number | 1639568132
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Entity Type | Individual
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Provider Name | LIZ M BETANCOURT PH.D
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Gender | Female
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 735 AVE PONCE DE LEON TORRE MEDICA DE AUXLIO MUTUO SUITE 203
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City | SAN JUAN
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State | PR
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Zip | 00917
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Country | US
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Telephone | 787-249-1353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1633
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City | TRUJILLO ALTO
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State | PR
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Zip | 00977-1633
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Country | US
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Telephone | 787-249-1353
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4077
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 4077
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License Number State | PR
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