Oghenefejiro M Etibo

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

148142 Issued in CA

Practice address

5 W 19TH St RM 3R
New York, NY 10011-4238

Phone

(510) 712-0016

NPI assigned

Jun 4, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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

• Bold Health Medical Group, a Professional Corporation

  dba Bold Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Encinitas, CA
  • NPI 1245749688
  NPD

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1336763325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 GREAT AMERICA PKWY",
            "address_2": "STE 320",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "95054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 W 19TH ST RM 3R",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100114238",
            "telephone_number": "510-712-0016"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "PO Box 746877",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303746877",
            "country_code": "US",
            "telephone_number": "510-712-0016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETIBO",
        "first_name": "OGHENEFEJIRO",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-04",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "148142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Etheridge, MD
• Michael A Etheridge, LMSW
• Ethical Drug Inc (san nicholas pharmacy)
• Ethics Dental Ipa, Inc
• Ethnik Nutrition Practice LLC
• Amandine Valerie Etienne
• Cindy Etienne, WHNP
• Darrio Etienne, RN
• Narline Etienne
• Suhas Krishna Etigunta

• Marriage & Family Therapist in New York, NY
• Providers in New York, NY by specialty
• Marriage & Family Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.