Provider Demographics
NPI:1366846529
Name:ETTMAN, RACHELLE (MS ED)
Entity Type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:
Last Name:ETTMAN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 CYPRESS AVE
Mailing Address - Street 2:APT. 10J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1305
Mailing Address - Country:US
Mailing Address - Phone:718-375-2505
Mailing Address - Fax:
Practice Address - Street 1:3841 CYPRESS AVE
Practice Address - Street 2:APT. 10J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1305
Practice Address - Country:US
Practice Address - Phone:718-375-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist