Shannon Joel Otto, LMSW – Clinical Social Worker

Key facts

NPI: 1114049673
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: M-05899 (NM)
Practice address: 220 4TH Ave
Raton, NM 87740-2643
Phone: (575) 445-2754
Fax: (575) 445-2225
NPI assigned: Apr 4, 2007
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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.

Noesis Integrative Health Inc Mental Health Clinic/Center (Including Community Mental Health Center) · Raton, NM · NPI 1780162206

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
M-05899	NM	MD	Clinical Social Worker
313365	NM	MD	School Social Worker

Practice roles

Organization	Specialty	Status	New patients
Noesis Integrative Health Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
School Social Worker	1041S0200X	313365	NM
Clinical Social Worker	1041C0700X	M-05899	NM	Yes

Addresses

Primary practice location

220 4TH Ave
Raton, NM 87740-2643

Mailing address

330 S 7TH St
Raton, NM 87740-4049
Phone (575) 390-1958

Other identifiers

Identifier	Type	State	Issuer
13829068	Medicaid	NM

Other providers in Raton, NM

All providers in Raton, NM · Clinical Social Worker in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.