MEDICARE: IVELISSE BETANCOURT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609224955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVELISSE BETANCOURT

Provider Business Mailing Address
First Line	:	7020 NW 177TH ST # B-103
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6291
Country	:	US
Telephone Number	:	305-305-7165
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 NW 177TH ST # B-103
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6291
Country	:	US
Telephone Number	:	305-305-7165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	03/09/2026

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Directions to “ IVELISSE BETANCOURT ” Practice Location

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