Healthcare Provider Details

I. General information

NPI: 1215359278
Provider Name (Legal Business Name): MARIA ESMERALDA OTAME LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA ESMERALDA REYES

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W SAHARA AVE
LAS VEGAS NV
89146-3406
US

IV. Provider business mailing address

P.O. DRAWER 70
ANTHONY NM
88047-0070
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-2273
  • Fax:
Mailing address:
  • Phone: 575-882-6101
  • Fax: 575-882-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09919
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7601-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: