MEDICARE: KEYRA D BETANCOURT 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	1041C0700X	Clinical Social Worker	9164	PR

General Provider Information

NPI Number	:	1891645263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYRA D BETANCOURT BETANCOURT

Provider Business Mailing Address
First Line	:	URB. ROYAL PALM, CALLE AZALEA,
Second Line	:	IA 29
City	:	BAYAMON
State	:	PR
Zip	:	00956-3117
Country	:	US
Telephone Number	:	787-414-4713
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB RIVERVIEW, CALLE 1,
Second Line	:	HH-1, SUITE 104
City	:	BAYAMON
State	:	PR
Zip	:	00961
Country	:	US
Telephone Number	:	787-414-4713
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/26/2026

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