Provider Demographics
NPI:1528548807
Name:OTERO, KAIRA M (LMSW)
Entity Type:Individual
Prefix:
First Name:KAIRA
Middle Name:M
Last Name:OTERO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-8042
Mailing Address - Country:US
Mailing Address - Phone:347-474-8464
Mailing Address - Fax:212-691-5635
Practice Address - Street 1:148 WILSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-8042
Practice Address - Country:US
Practice Address - Phone:347-474-8464
Practice Address - Fax:212-691-5635
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP12170104100000X
NY105746104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker