Provider Demographics
NPI:1801179379
Name:ETIENNE, RICHANE (BSW)
Entity Type:Individual
Prefix:
First Name:RICHANE
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 AVENUE H E
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-3609
Mailing Address - Country:US
Mailing Address - Phone:561-389-2571
Mailing Address - Fax:
Practice Address - Street 1:3113 AVENUE H E
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-3609
Practice Address - Country:US
Practice Address - Phone:561-389-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker