Provider Demographics
NPI:1013115518
Name:OTTE, LARA GUILLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:GUILLE
Last Name:OTTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6838
Mailing Address - Country:US
Mailing Address - Phone:415-775-8760
Mailing Address - Fax:415-206-9340
Practice Address - Street 1:244 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6838
Practice Address - Country:US
Practice Address - Phone:415-775-8760
Practice Address - Fax:415-206-9340
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist