Provider Demographics
NPI:1760223556
Name:BETANCOURT, GLENN (MA, LAC NCC)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:MA, LAC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY RD STE 92
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1669
Mailing Address - Country:US
Mailing Address - Phone:201-538-4565
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD STE 92
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1669
Practice Address - Country:US
Practice Address - Phone:855-500-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00612900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional