Provider Demographics
NPI:1437784337
Name:OTPCCET LLC
Entity Type:Organization
Organization Name:OTPCCET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-401-4712
Mailing Address - Street 1:39 HILLSIDE TER
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2534
Mailing Address - Country:US
Mailing Address - Phone:845-637-2775
Mailing Address - Fax:845-637-2774
Practice Address - Street 1:39 HILLSIDE TER
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2534
Practice Address - Country:US
Practice Address - Phone:845-637-2775
Practice Address - Fax:845-637-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty