Provider Demographics
NPI:1982435137
Name:VIERA BETANCOURT, YULIESY IV
Entity type:Individual
Prefix:
First Name:YULIESY
Middle Name:
Last Name:VIERA BETANCOURT
Suffix:IV
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 1:3435 TACONIC DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5048
Mailing Address - Country:US
Mailing Address - Phone:561-410-8751
Mailing Address - Fax:
Practice Address - Street 1:3435 TACONIC DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5048
Practice Address - Country:US
Practice Address - Phone:561-410-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLV613960948660106S00000X
FL613960948660106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician