Provider Demographics
NPI:1740486059
Name:OTERO, MARTA ELENA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:ELENA
Last Name:OTERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4800 OVERTON PLZ
Mailing Address - Street 2:SUITE #320
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4428
Mailing Address - Country:US
Mailing Address - Phone:817-735-1866
Mailing Address - Fax:817-735-8838
Practice Address - Street 1:4800 OVERTON PLZ
Practice Address - Street 2:SUITE #320
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4428
Practice Address - Country:US
Practice Address - Phone:817-735-1866
Practice Address - Fax:817-735-8838
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical