Healthcare Provider Details

I. General information

NPI: 1962182691
Provider Name (Legal Business Name): ALEXANDRA OTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOSTON AVE STE 1925
MEDFORD MA
02155-4243
US

IV. Provider business mailing address

1236 HILLTOP DR
WALPOLE MA
02081-4416
US

V. Phone/Fax

Practice location:
  • Phone: 617-533-0416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: