Provider Demographics
NPI:1699317172
Name:DIAZ BETANCOURT, MARIA E
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:DIAZ BETANCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 NW 17TH AVE STE 272
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2562
Mailing Address - Country:US
Mailing Address - Phone:561-865-7064
Mailing Address - Fax:561-501-5413
Practice Address - Street 1:1300 NW 17TH AVE STE 272
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2562
Practice Address - Country:US
Practice Address - Phone:561-865-7064
Practice Address - Fax:561-501-5413
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-101901106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-19-101901OtherREGISTERED BEHAVIOR TECHNICIAN