Healthcare Provider Details

I. General information

NPI: 1427960962
Provider Name (Legal Business Name): MAYRA RESTREPO OTALVARO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 89TH ST APT BSMNT
BROOKLYN NY
11209-5553
US

IV. Provider business mailing address

155 89TH ST APT BSMNT
BROOKLYN NY
11209-5553
US

V. Phone/Fax

Practice location:
  • Phone: 646-789-2824
  • Fax:
Mailing address:
  • Phone: 646-789-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: