Provider Demographics
NPI:1740004480
Name:DENIS, EMMANUELLA ETIENNE (EDD)
Entity type:Individual
Prefix:DR
First Name:EMMANUELLA
Middle Name:ETIENNE
Last Name:DENIS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 TOWN RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7575
Mailing Address - Country:US
Mailing Address - Phone:857-258-6039
Mailing Address - Fax:
Practice Address - Street 1:453 TOWN RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7575
Practice Address - Country:US
Practice Address - Phone:857-258-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor