Healthcare Provider Details

I. General information

NPI: 1578252698
Provider Name (Legal Business Name): RAEANNE VICTORIA ETLINGER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 THIRZA PL
RAHWAY NJ
07065-2706
US

IV. Provider business mailing address

1113 THIRZA PL
RAHWAY NJ
07065-2706
US

V. Phone/Fax

Practice location:
  • Phone: 908-400-4661
  • Fax:
Mailing address:
  • Phone: 908-400-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00960700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: