Provider Demographics
NPI:1336238906
Name:OTREMBA, JAMES CURTIS (LICSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CURTIS
Last Name:OTREMBA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 STEARNS WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1275
Mailing Address - Country:US
Mailing Address - Phone:320-253-3540
Mailing Address - Fax:
Practice Address - Street 1:2025 STEARNS WAY STE 111
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1275
Practice Address - Country:US
Practice Address - Phone:320-253-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical