Provider Demographics
NPI:1487071080
Name:BETANCOURT, JENNY (LMHC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5821
Mailing Address - Country:US
Mailing Address - Phone:786-221-0940
Mailing Address - Fax:305-503-7363
Practice Address - Street 1:11440 N KENDALL DR
Practice Address - Street 2:STE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1024
Practice Address - Country:US
Practice Address - Phone:305-891-0050
Practice Address - Fax:305-891-4228
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health