Provider Demographics
NPI:1861899593
Name:BETANCOURT, PAULINE (MSW INTERN, BS)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:MSW INTERN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LAS LOMAS DR
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7171
Mailing Address - Country:US
Mailing Address - Phone:714-525-3776
Mailing Address - Fax:
Practice Address - Street 1:301 LAS LOMAS DR
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7171
Practice Address - Country:US
Practice Address - Phone:714-525-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical