MEDICARE: MS. MARY LOUISE QUINT LCSW

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	1041C0700X	Clinical Social Worker	MT538LCSW	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265452643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY LOUISE QUINT LCSW

Provider Business Mailing Address
First Line	:	600 CENTRAL PLAZA
Second Line	:	STE 300
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3141
Country	:	US
Telephone Number	:	406-452-1171
Fax Number	:	406-452-4412

Provider Business Practice Location Address
First Line	:	600 CENTRAL PLAZA
Second Line	:	STE 300
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3141
Country	:	US
Telephone Number	:	406-452-1171
Fax Number	:	406-452-4412

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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