Provider Demographics
NPI:1659798312
Name:OTTO, DAVID (PLMSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:OTTO
Suffix:
Gender:M
Credentials:PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 ESPLANADE CIR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-7619
Mailing Address - Country:US
Mailing Address - Phone:505-464-1126
Mailing Address - Fax:
Practice Address - Street 1:2218 SOUTHERN BLVD SE STE 14
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3750
Practice Address - Country:US
Practice Address - Phone:505-994-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2025-06011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical