| Etta Ettlinger, Lcsw, Pa | |
|
100 Executive Way Ste 110 Ponte Vedra FL 32082-4753 | |
| (904) 273-4099 | |
| (904) 273-4095 |
| Full Name | Etta Ettlinger, Lcsw, Pa |
|---|---|
| Speciality | Social Worker |
| Location | 100 Executive Way Ste 110, Ponte Vedra, Florida |
| Authorized Official Name and Position | Etta F. Ettlinger (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9042734099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Etta Ettlinger, Lcsw, Pa 100 Executive Way Ste 110 Ponte Vedra FL 32082-4753 Ph: (904) 273-4099 | Etta Ettlinger, Lcsw, Pa 100 Executive Way Ste 110 Ponte Vedra FL 32082-4753 Ph: (904) 273-4099 |
| NPI Number | 1932384351 |
|---|---|
| Provider Enumeration Date | 01/03/2008 |
| Last Update Date | 01/03/2008 |
| Medicare PECOS PAC ID | 4587624135 |
|---|---|
| Medicare Enrollment ID | O20041018000704 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932384351 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW6310 (Florida) | Primary |
| Provider Name | Etta F Ettlinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144207713 PECOS PAC ID: 6204896863 Enrollment ID: I20041021000229 |
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