Provider Demographics
NPI:1699287524
Name:BETANCOURT-TRUJILLO, MARIA (PHD (C))
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BETANCOURT-TRUJILLO
Suffix:
Gender:F
Credentials:PHD (C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214E E MOUNTAIN ST APT 100
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1234
Mailing Address - Country:US
Mailing Address - Phone:787-938-6010
Mailing Address - Fax:
Practice Address - Street 1:214E E MOUNTAIN ST APT 100
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1234
Practice Address - Country:US
Practice Address - Phone:787-938-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis