| Doctor Name: | ETTA F. ETTLINGER |
| NPI Number: | 1144207713 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LCSW6310 |
| Business Practice Address: | 100 Executive Way Suite #110 Ponte Vedra, FL - 320824753 |
| Business Phone Number: | 9042734099 |
| Business Fax Number: | 9042734095 |
| Mailing Address: | 100 Executive Way, Suite #110 PONTE VEDRA |
| State: | FL |
| Postal Code: | 320824753 |
| Phone Number: | 9042734099 |
| Fax Number: | 9042734095 |
| NPI Enumeration Date: | 12/27/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW6310 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |