Active NPI
Rebecca Grace Etkin, PHD
- Psychologist
- New Haven, CT
National Provider Identifier
1548757289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 8.004113
- Practice address
- 350 George St
New Haven, CT 06511-6617 - Phone
- (917) 737-4644
- NPI assigned
- Apr 18, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 8.004113 | CT | Primary |
Addresses
Primary practice location
350 George St
New Haven, CT 06511-6617
Mailing address
350 George St
New Haven, CT 06511-6617
Phone (917) 737-4644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8.004113 | CT | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645574400000",
"number": "1548757289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 GEORGE ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065116617",
"telephone_number": "917-737-4644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 GEORGE ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065116617",
"telephone_number": "917-737-4644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETKIN",
"first_name": "REBECCA",
"middle_name": "GRACE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-18",
"last_updated": "2022-02-23",
"certification_date": "2022-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CT",
"license": "8.004113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.