Individual
SANDRA EMERIC OTERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2363 N CALIFORNIA AVE, CHICAGO, IL 60647-2939
(773) 786-2514
Mailing address
PO BOX 478920, CHICAGO, IL 60647-8920
(773) 786-2514
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007 1647960
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/31/2006
Last updated
07/08/2007
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