Provider Demographics
NPI:1487990107
Name:BETANCOURT, WILLIAM JR (ED)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:BETANCOURT
Suffix:JR
Gender:M
Credentials:ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 BRONX RIVER RD.
Mailing Address - Street 2:UNIT A36
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708
Mailing Address - Country:US
Mailing Address - Phone:914-439-9295
Mailing Address - Fax:
Practice Address - Street 1:790 BRONX RIVER RD.
Practice Address - Street 2:UNIT A36
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708
Practice Address - Country:US
Practice Address - Phone:914-439-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY563063252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency