Provider Demographics
NPI:1740723592
Name:OTERO, LORRAINE (LCSW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45455 BLACKFOOT WAY
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-8563
Mailing Address - Country:US
Mailing Address - Phone:760-393-3308
Mailing Address - Fax:
Practice Address - Street 1:46057 OASIS ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5906
Practice Address - Country:US
Practice Address - Phone:760-393-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical