Provider Demographics
NPI:1053654806
Name:ETIENNE, VASHONNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VASHONNA
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:VASHONNA
Other - Middle Name:
Other - Last Name:HASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2410 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4004
Mailing Address - Country:US
Mailing Address - Phone:201-491-6060
Mailing Address - Fax:201-346-4365
Practice Address - Street 1:297 KINDERKAMACK RD
Practice Address - Street 2:SUITE 214
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1538
Practice Address - Country:US
Practice Address - Phone:201-491-6060
Practice Address - Fax:201-438-2984
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055378001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical