Provider Demographics
NPI:1245493790
Name:OTERO, MARIELA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARIELA
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:MARIELA
Other - Middle Name:
Other - Last Name:OTERO-AGUIAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:11031 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7182
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:305-398-6099
Practice Address - Street 1:17563 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5435
Practice Address - Country:US
Practice Address - Phone:786-293-9544
Practice Address - Fax:786-293-9594
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8200101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004248000Medicaid
FL004020200Medicaid