Provider Demographics
NPI:1053023242
Name:ETIENNE, MARJORIE I
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:ETIENNE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NEWKIRK AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7388
Mailing Address - Country:US
Mailing Address - Phone:347-593-7008
Mailing Address - Fax:
Practice Address - Street 1:1900 NEWKIRK AVE APT 2F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7388
Practice Address - Country:US
Practice Address - Phone:347-593-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling