Provider Demographics
NPI:1902118193
Name:ANSEL, ETTA (RCSW)
Entity Type:Individual
Prefix:MRS
First Name:ETTA
Middle Name:
Last Name:ANSEL
Suffix:
Gender:F
Credentials:RCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SPRING ROCK PL
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1715
Mailing Address - Country:US
Mailing Address - Phone:917-656-6216
Mailing Address - Fax:
Practice Address - Street 1:5 SPRING ROCK PL
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1715
Practice Address - Country:US
Practice Address - Phone:917-656-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR014929-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical