Individual provider Active NPI

Lisiel Betancourt

  • Social Worker
  • Coral Gables, FL
National Provider Identifier
1558024067
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
CBHCM102823 Issued in FL
Practice address
4649 Ponce de Leon Blvd Ste 404
Coral Gables, FL 33146-2121
Phone
(786) 536-9714
Fax
(786) 536-9833
NPI assigned
Oct 21, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X CBHCM102823 FL Primary

Addresses

Primary practice location

4649 Ponce de Leon Blvd Ste 404
Coral Gables, FL 33146-2121

Mailing address

4649 Ponce de Leon Blvd Ste 404
Coral Gables, FL 33146-2121
Phone (786) 536-9714

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CBHCM102823FLMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Abcs for Success, LLC CurrentSince Oct 24, 2021 Accepting new patients

Locations

4649 Ponce de Leon Blvd
Ste 404
Coral Gables, FL 33146

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1558024067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4649 PONCE DE LEON BLVD STE 404",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331462121",
            "telephone_number": "786-536-9714",
            "fax_number": "786-536-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4649 PONCE DE LEON BLVD STE 404",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331462121",
            "telephone_number": "786-536-9714",
            "fax_number": "786-536-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETANCOURT",
        "first_name": "LISIEL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "CBHCM102823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coral Gables, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.