Provider Demographics
NPI:1104630425
Name:ETIENNE, NEYSA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:NEYSA
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:NEYSA
Other - Middle Name:
Other - Last Name:ETIENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NEYSA ACOSTA
Mailing Address - Street 1:45 WHARTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-2310
Mailing Address - Country:US
Mailing Address - Phone:973-767-4334
Mailing Address - Fax:
Practice Address - Street 1:9 FISHERS LN
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2440
Practice Address - Country:US
Practice Address - Phone:973-726-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100239500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist