Provider Demographics
NPI:1518701960
Name:PINO-VAN ETTEN, JENAE JACQUELINE (LMSW)
Entity type:Individual
Prefix:
First Name:JENAE
Middle Name:JACQUELINE
Last Name:PINO-VAN ETTEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 N BRAESWOOD BLVD APT 410
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2898
Mailing Address - Country:US
Mailing Address - Phone:505-850-0995
Mailing Address - Fax:505-850-0995
Practice Address - Street 1:4550 N BRAESWOOD BLVD APT 410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-2898
Practice Address - Country:US
Practice Address - Phone:505-850-0995
Practice Address - Fax:505-850-0995
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1100411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical