=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275841702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE OTERO-CASTILLO LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2010
-----------------------------------------------------
Last Update Date | 09/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12054 SW 116TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-253-5480
-----------------------------------------------------
Fax | 305-480-7078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12054 SW 116TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-253-5480
-----------------------------------------------------
Fax | 305-480-7078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH9657
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------