Healthcare Provider Details

I. General information

NPI: 1003428319
Provider Name (Legal Business Name): JEANNIE LEE ROSARIO OTERO PLC, MHS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 CALLE SAN AGUSTIN # 321
SAN JUAN PR
00901-2954
US

IV. Provider business mailing address

I58 CALLE CAPITAN CORREA
BAYAMON PR
00959-4973
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4829
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8889
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: