Individual
ALLISYA OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Mailing address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
C-11176
NM
1041C0700X
Clinical Social Worker
—
—
1041S0200X
School Social Worker
—
—
Other
Enumeration date
08/25/2017
Last updated
09/16/2024
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