Glenda L. Bravo Otero, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6619 Issued in PR

Practice address

Urb. San Antonio 345
Calle Aguacate San Antonio PR
Aguadilla, PR 00690

Phone

(787) 543-8953

NPI assigned

Nov 27, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Glenda Lia Bravo Otero Former name

Medicare fee-for-service enrollment

Enrolled in PR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Migrant Health Center Western Region,Inc

  • Federally Qualified Health Center (FQHC)
  • Mayaguez, PR
  • NPI 1609969286

  Single Specialty

  Medicare reassignment NPD
• Migrant Health Center Western Region, Inc.

  • Clinic Pharmacy
  • Yauco, PR
  • NPI 1093262297
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1003150301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "URB. SAN ANTONIO 345",
            "address_2": "CALLE AGUACATE SAN ANTONIO PR",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "00690",
            "telephone_number": "787-543-8953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "URB. SAN ANTONIO 345",
            "address_2": "CALLE AGUACATE SAN ANTONIO PR",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "00690",
            "telephone_number": "787-543-8953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Urb-Sol Y Mar 247",
            "address_purpose": "LOCATION",
            "city": "Isabela",
            "state": "PR",
            "postal_code": "00662",
            "country_code": "US",
            "telephone_number": "787-806-1687",
            "fax_number": "787-806-1688",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAVO OTERO",
        "first_name": "GLENDA",
        "middle_name": "L.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-27",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PR",
            "license": "10466",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "6619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLENDA",
            "last_name": "BRAVO OTERO",
            "middle_name": "LIA",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Psychologist in Aguadilla, PR
• Providers in Aguadilla, PR by specialty
• Clinical Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.