Provider Demographics
NPI:1598357394
Name:OTERO, JANIRIS NAOMI
Entity Type:Individual
Prefix:
First Name:JANIRIS
Middle Name:NAOMI
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 1:70 DUNHAM ST # 2
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3050
Mailing Address - Country:US
Mailing Address - Phone:617-319-9316
Mailing Address - Fax:
Practice Address - Street 1:70 DUNHAM ST # 2
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3050
Practice Address - Country:US
Practice Address - Phone:617-319-9316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician