Provider Demographics
NPI:1861593725
Name:OTIS, HARRIET ALISON (MA)
Entity type:Individual
Prefix:MS
First Name:HARRIET
Middle Name:ALISON
Last Name:OTIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:HARRIET
Other - Middle Name:OTIS
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:6 SHADY HILL AVE
Mailing Address - City:NUTTING LAKE
Mailing Address - State:MA
Mailing Address - Zip Code:01865-0284
Mailing Address - Country:US
Mailing Address - Phone:978-663-9235
Mailing Address - Fax:978-663-9235
Practice Address - Street 1:438 KING ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1269
Practice Address - Country:US
Practice Address - Phone:978-952-6060
Practice Address - Fax:978-486-8104
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA461178Medicare UPIN
MALM0945Medicare UPIN
MA006639Medicare UPIN