Healthcare Provider Details

I. General information

NPI: 1578468807
Provider Name (Legal Business Name): JAIMINIQUE ETIENNE LCSW P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 NEVADA ST
LINDENHURST NY
11757-5206
US

IV. Provider business mailing address

334 NEVADA ST
LINDENHURST NY
11757-5206
US

V. Phone/Fax

Practice location:
  • Phone: 631-320-8697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAIMINIQUE ETIENNE
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 631-320-8697