Provider Demographics
NPI:1215663265
Name:BETANCOURT, ALICIA DIONNE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:DIONNE
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 W PATRICK CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4566
Mailing Address - Country:US
Mailing Address - Phone:386-589-7324
Mailing Address - Fax:
Practice Address - Street 1:1030 W PATRICK CIR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4566
Practice Address - Country:US
Practice Address - Phone:386-589-7324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW201981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty