Provider Demographics
NPI:1447077342
Name:OTERO VAZQUEZ, BARBARA M (PHD, CHT)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:M
Last Name:OTERO VAZQUEZ
Suffix:
Gender:F
Credentials:PHD, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOS ARBOLES 189 CALLE GRANADA
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:939-326-4245
Mailing Address - Fax:
Practice Address - Street 1:111 CALLE DUFRESNE W
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3601
Practice Address - Country:US
Practice Address - Phone:939-326-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical