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Individual

JASON OTTERBECK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CASAC-T

Contact information

Practice address
6 MIDDLE COUNTRY RD, MIDDLE ISLAND, NY 11953-2516
(631) 946-6060
(631) 946-6063
Mailing address
6 MIDDLE COUNTRY RD, MIDDLE ISLAND, NY 11953-2516
(631) 946-6060
(631) 946-6063

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
34592
NY

Other

Enumeration date
10/15/2019
Last updated
10/15/2019
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