Healthcare Provider Details

I. General information

NPI: 1851429427
Provider Name (Legal Business Name): MADALYN S OTERO SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 6TH ST NW GARFIELD MS
ALBUQUERQUE NM
87107-2418
US

IV. Provider business mailing address

3501 6TH ST NW GARFIELD MS
ALBUQUERQUE NM
87107-2418
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-1647
  • Fax:
Mailing address:
  • Phone: 505-344-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI 4816
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI 4816
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: