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General NPI Number Information
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NPI Number | 1003150301
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Entity Type | Individual
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Provider Name | GLENDA L. BRAVO OTERO PSY.D
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Gender | Female
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | URB. SAN ANTONIO 345 CALLE AGUACATE SAN ANTONIO PR
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City | AGUADILLA
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State | PR
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Zip | 00690
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Country | US
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Telephone | 787-543-8953
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Fax |
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Provider Business Mailing Address
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Address Line | URB. SAN ANTONIO 345 CALLE AGUACATE SAN ANTONIO PR
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City | AGUADILLA
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State | PR
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Zip | 00690
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Country | US
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Telephone | 787-543-8953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10466
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6619
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License Number State | PR
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