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General NPI Number Information
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NPI Number | 1003428319
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Entity Type | Individual
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Provider Name | JEANNIE LEE ROSARIO OTERO PLC, MHS, PHD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 900 CALLE CERRA
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City | SAN JUAN
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State | PR
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Zip | 00907-5104
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Country | US
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Telephone | 787-480-3788
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Fax |
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Provider Business Mailing Address
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Address Line | I58 CALLE CAPITAN CORREA
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City | BAYAMON
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State | PR
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Zip | 00959-4973
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8889
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4829
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License Number State | PR
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