Provider Demographics
NPI:1336631951
Name:OTERO, SARINA BEGAY
Entity type:Individual
Prefix:
First Name:SARINA
Middle Name:BEGAY
Last Name:OTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10240 N 31ST AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9564
Mailing Address - Country:US
Mailing Address - Phone:602-863-1862
Mailing Address - Fax:602-863-4388
Practice Address - Street 1:10240 N 31ST AVE STE 122
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9564
Practice Address - Country:US
Practice Address - Phone:602-863-1862
Practice Address - Fax:602-863-4388
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW11850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional