Provider Demographics
NPI:1902345192
Name:OTTEN CARRANZA, ASTRID MARINA DEL ROSARIO (MD)
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:MARINA DEL ROSARIO
Last Name:OTTEN CARRANZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9371
Mailing Address - Country:US
Mailing Address - Phone:315-779-5060
Mailing Address - Fax:315-779-5028
Practice Address - Street 1:1575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9371
Practice Address - Country:US
Practice Address - Phone:315-779-5060
Practice Address - Fax:315-779-5028
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2877802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry