Provider Demographics
NPI:1124670047
Name:ETIENNE, ETIANNA A (PHD CANDIDATE)
Entity type:Individual
Prefix:
First Name:ETIANNA
Middle Name:A
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:PHD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RUGGLES ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2037
Mailing Address - Country:US
Mailing Address - Phone:781-299-3462
Mailing Address - Fax:
Practice Address - Street 1:9 RUGGLES ST APT 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-2037
Practice Address - Country:US
Practice Address - Phone:781-299-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty