Provider Demographics
NPI:1184000671
Name:BORROMEO-OTTY, JEANNE (LCSW-R)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BORROMEO-OTTY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 STATE ROUTE 143
Mailing Address - Street 2:
Mailing Address - City:COEYMANS HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:12046-2106
Mailing Address - Country:US
Mailing Address - Phone:518-755-6424
Mailing Address - Fax:
Practice Address - Street 1:40 COLVIN AVE FL 2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1104
Practice Address - Country:US
Practice Address - Phone:518-605-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0797971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty