Provider Demographics
NPI:1578252698
Name:ETLINGER, RAEANNE VICTORIA (MA)
Entity Type:Individual
Prefix:MS
First Name:RAEANNE
Middle Name:VICTORIA
Last Name:ETLINGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 THIRZA PL
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2706
Mailing Address - Country:US
Mailing Address - Phone:908-400-4661
Mailing Address - Fax:
Practice Address - Street 1:1113 THIRZA PL
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2706
Practice Address - Country:US
Practice Address - Phone:908-400-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist