Provider Demographics
NPI:1275841702
Name:OTERO-CASTILLO, MICHELE (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:OTERO-CASTILLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12054 SW 116TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5104
Mailing Address - Country:US
Mailing Address - Phone:786-253-5480
Mailing Address - Fax:305-480-7078
Practice Address - Street 1:12054 SW 116TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5104
Practice Address - Country:US
Practice Address - Phone:786-253-5480
Practice Address - Fax:305-480-7078
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health