Healthcare Provider Details

I. General information

NPI: 1710692603
Provider Name (Legal Business Name): VANESSA OTERO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA GARCIA

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EXECUTIVE CENTER DR
WEST PALM BEACH FL
33401-4849
US

IV. Provider business mailing address

1400 VILLAGE BLVD APT 523
WEST PALM BEACH FL
33409-2845
US

V. Phone/Fax

Practice location:
  • Phone: 561-697-5500
  • Fax:
Mailing address:
  • Phone: 201-687-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: