Healthcare Provider Details

I. General information

NPI: 1942636816
Provider Name (Legal Business Name): ANDREA NICOLE OTERO-LOONEY MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 TUNDRA SWAN CT NW
ALBUQUERQUE NM
87120-4113
US

IV. Provider business mailing address

3901 TUNDRA SWAN CT NW
ALBUQUERQUE NM
87120-4113
US

V. Phone/Fax

Practice location:
  • Phone: 505-980-8441
  • Fax:
Mailing address:
  • Phone: 505-980-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: