Provider Demographics
NPI:1770289647
Name:BETANCOURT MARTINEZ, SARA VIRGINIA (LAMFT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:VIRGINIA
Last Name:BETANCOURT MARTINEZ
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BELLA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-4804
Mailing Address - Country:US
Mailing Address - Phone:646-404-0008
Mailing Address - Fax:
Practice Address - Street 1:15 FARVIEW TER
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2761
Practice Address - Country:US
Practice Address - Phone:646-404-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00034100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty