Provider Demographics
NPI:1568715449
Name:OTERO, LEAMSY
Entity Type:Individual
Prefix:MRS
First Name:LEAMSY
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0077
Mailing Address - Country:US
Mailing Address - Phone:787-603-7267
Mailing Address - Fax:
Practice Address - Street 1:CARR 840 KM 1.4
Practice Address - Street 2:ROYAL TOWN BO LA ALDEA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-603-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4159103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling