Provider Demographics
NPI:1891923132
Name:WHYTE-ETERE, ANTONETTE JULENE (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:ANTONETTE
Middle Name:JULENE
Last Name:WHYTE-ETERE
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SPUR DR N
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3432
Mailing Address - Country:US
Mailing Address - Phone:631-665-9291
Mailing Address - Fax:
Practice Address - Street 1:430 SPUR DR N
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-3432
Practice Address - Country:US
Practice Address - Phone:631-665-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10901101YA0400X
NYR0534231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)