Provider Demographics
NPI:1790067924
Name:OTERO CORDERO, CARMEN TERESITA (TS)
Entity Type:Individual
Prefix:MISS
First Name:CARMEN
Middle Name:TERESITA
Last Name:OTERO CORDERO
Suffix:
Gender:F
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. PARQUE DE LA VISTA 2 1294
Mailing Address - Street 2:CALLE JUAN BAIZ APT 2133
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-1203
Mailing Address - Country:US
Mailing Address - Phone:787-426-6161
Mailing Address - Fax:
Practice Address - Street 1:COND. PARQUE DE LA VISTA 2 1294
Practice Address - Street 2:CALLE JUAN BAIZ APT 2133
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-1203
Practice Address - Country:US
Practice Address - Phone:787-426-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10436104100000X
PR7039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR#10436OtherSOCIAL WORKER
PR7039OtherPSCOLOGA CLNICA