Provider Demographics
NPI:1881493146
Name:OTERO, CHRISTA MARIE (RCSWI)
Entity type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:MARIE
Last Name:OTERO
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6084 SAGE WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVIILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244
Mailing Address - Country:US
Mailing Address - Phone:203-613-4316
Mailing Address - Fax:203-613-4316
Practice Address - Street 1:5655 TIMUQUANA RD STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8914
Practice Address - Country:US
Practice Address - Phone:904-710-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW202561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty