Etta Ettlinger, LCSW, PA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW6310 Issued in FL

Legal business name

ETTA ETTLINGER, LCSW, PA

Practice address

100 Executive Way Ste 110
Ponte Vedra, FL 32082-4753

Phone

(904) 273-4099

Fax

(904) 273-4095

NPI assigned

Jan 3, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Etta F. Ettlinger, LCSWNPI 1144207713

Title

Clinical Social Worker

Phone

(904) 273-4099

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Etta F. Ettlinger, LCSW

  • Clinical Social Worker
  • Ponte Vedra, FL
  • NPI 1144207713
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1932384351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 EXECUTIVE WAY STE 110",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320824753",
            "telephone_number": "904-273-4099",
            "fax_number": "904-273-4095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EXECUTIVE WAY STE 110",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320824753",
            "telephone_number": "904-273-4099",
            "fax_number": "904-273-4095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETTA ETTLINGER, LCSW, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "ETTLINGER",
        "authorized_official_first_name": "ETTA",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "904-273-4099",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW6310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Darla Elkhoury, DMD
• Endodontics 2 PLLC
• Zachary Engel, DPT
• David Engelman, MA
• Caterina Therese Eppolito
• Etta F. Ettlinger, LCSW
• David Falden, OD
• Mark David Fay, P.T.
• Femmewell Holdings LLC (Femmewell)
• Naara Ferguson, RN

• Clinical Social Worker in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.