MEDICARE: MONICA SUE QUINN LMHC

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	101YM0800X	Mental Health Counselor	12365	FL

General Provider Information

NPI Number	:	1437640604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA SUE QUINN LMHC

Provider Business Mailing Address
First Line	:	7232 LUMBER PORT DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-0131
Country	:	US
Telephone Number	:	941-545-3247
Fax Number	:

Provider Business Practice Location Address
First Line	:	7232 LUMBER PORT DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-0131
Country	:	US
Telephone Number	:	941-545-3247
Fax Number	:

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

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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