Provider Demographics
NPI:1598720187
Name:ETTING, MARISA E (MA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:E
Last Name:ETTING
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 1:194 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4015
Mailing Address - Country:US
Mailing Address - Phone:401-633-2929
Mailing Address - Fax:888-602-6957
Practice Address - Street 1:194 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4015
Practice Address - Country:US
Practice Address - Phone:401-633-2929
Practice Address - Fax:888-602-6957
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMHC00342OtherLCMHC
RI9011388OtherAETNA
RI33058-3OtherBLUE CROSS BLUE SHIELD
RIMS57711Medicaid
RI1094200OtherNEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND