Provider Demographics
NPI:1558704254
Name:ETTINGER, RENEE ELLEN (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:ELLEN
Last Name:ETTINGER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:ELLEN
Other - Last Name:EILERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:1101 S WINCHESTER BLVD STE N260
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3901
Mailing Address - Country:US
Mailing Address - Phone:925-808-1998
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD STE N260
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:925-808-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator