Provider Demographics
NPI:1083884357
Name:BETANCOURT VINCENTY, DESIREE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:M
Last Name:BETANCOURT VINCENTY
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-0364
Mailing Address - Country:US
Mailing Address - Phone:787-391-5660
Mailing Address - Fax:787-293-2700
Practice Address - Street 1:871 LA TORRE BUILDING
Practice Address - Street 2:CARR 876 KM 2.3 URB. LOURDES
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3813
Practice Address - Country:US
Practice Address - Phone:787-391-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR39891400Medicaid