Individual provider Active NPI

Neysa Etienne, LMFT

  • Marriage & Family Therapist
  • Sparta, NJ
National Provider Identifier
1104630425
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
37F100239500 Issued in NJ
Practice address
9 Fishers LN
Sparta, NJ 07871-2440
Phone
(973) 726-4533
NPI assigned
Feb 5, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 37F100239500 NJ Primary

Addresses

Primary practice location

9 Fishers LN
Sparta, NJ 07871-2440

Mailing address

45 Wharton Ave
Mine Hill, NJ 07803-2310
Phone (973) 767-4334

Other names 1

  • Mrs. Neysa Etienne Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250414002881 NJ Practitioner - Marriage and Family Therapist 1951825736 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Counseling Associates, LLC Marriage & Family Therapist CurrentSince Mar 1, 2025 Accepting new patients

Locations

30 Moran St
Newton, NJ 07860
Phone (973) 579-3101

9 Fishers Ln
Sparta, NJ 07871
Phone (973) 671-8786

9 Fishers Ln
Ste E
Sparta, NJ 07871
Phone (973) 600-3558

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1104630425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 WHARTON AVE",
            "city": "MINE HILL",
            "state": "NJ",
            "postal_code": "078032310",
            "telephone_number": "973-767-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 FISHERS LN",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078712440",
            "telephone_number": "973-726-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "NEYSA",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-05",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NJ",
            "license": "37F100239500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NEYSA",
            "last_name": "ETIENNE",
            "prefix": "MRS.",
            "credential": "NEYSA ACOSTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sparta, NJ

Sources for this page

Verify at the official NPI Registry.