Provider Demographics
NPI:1245470897
Name:OTERO VILLAFANE, LEGNA JENNIS I (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEGNA
Middle Name:JENNIS
Last Name:OTERO VILLAFANE
Suffix:I
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 371029
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1029
Mailing Address - Country:US
Mailing Address - Phone:787-595-9682
Mailing Address - Fax:787-687-5745
Practice Address - Street 1:URB. PRADERAS DE NAVARRO
Practice Address - Street 2:C 22 T8
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-595-9682
Practice Address - Fax:787-687-5745
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3274103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical