Provider Demographics
NPI:1639220734
Name:OTIS, SHARON ELIZABETH (EDD, PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ELIZABETH
Last Name:OTIS
Suffix:
Gender:F
Credentials:EDD, PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 ROYAL PALM DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-1305
Mailing Address - Country:US
Mailing Address - Phone:941-792-4988
Mailing Address - Fax:
Practice Address - Street 1:5910 CORTEZ RD W STE 160
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2706
Practice Address - Country:US
Practice Address - Phone:941-792-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-1682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health