MEDICARE: TARA QUINN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1114205549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA QUINN

Provider Business Mailing Address
First Line	:	348 13TH ST
Second Line	:	SUITE 203
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6177
Country	:	US
Telephone Number	:	718-788-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2804
Country	:	US
Telephone Number	:	914-522-9197
Fax Number	:

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

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	04/20/2012

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Directions to “ TARA QUINN ” Practice Location

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