MEDICARE: DAVID ETIENNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker	124422-01	NY

General Provider Information

NPI Number	:	1194684662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ETIENNE

Provider Business Mailing Address
First Line	:	1218 REMSEN AVE # 2F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1218 REMSEN AVE # 2F
Second Line	:	2F
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3925
Country	:	US
Telephone Number	:	929-377-4857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ DAVID ETIENNE ” Practice Location

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