Provider Demographics
NPI:1851568463
Name:OTERO, DINORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:DINORAH
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 37TH AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6300
Mailing Address - Country:US
Mailing Address - Phone:718-672-1705
Mailing Address - Fax:718-672-2027
Practice Address - Street 1:7409 37TH AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6300
Practice Address - Country:US
Practice Address - Phone:718-672-1705
Practice Address - Fax:718-672-2027
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0763381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical