Individual
MARISA E ETTING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
194 WATERMAN ST, PROVIDENCE, RI 02906-4015
(401) 633-2929
(888) 602-6957
Mailing address
194 WATERMAN ST, PROVIDENCE, RI 02906-4015
(401) 633-2929
(888) 602-6957
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1094200
NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
RI
01
—
33058-3
BLUE CROSS BLUE SHIELD
RI
01
—
9011388
AETNA
RI
01
—
MHC00342
LCMHC
RI
05
—
MS57711
—
RI
Enumeration date
04/18/2006
Last updated
07/21/2022
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