Provider Demographics
NPI:1215359278
Name:OTAME, MARIA ESMERALDA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ESMERALDA
Last Name:OTAME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ESMERALDA
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. DRAWER 70
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88047-0070
Mailing Address - Country:US
Mailing Address - Phone:575-882-6101
Mailing Address - Fax:575-882-6926
Practice Address - Street 1:5100 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3406
Practice Address - Country:US
Practice Address - Phone:702-799-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-099191041C0700X
NV7601-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical