Healthcare Provider Details

I. General information

NPI: 1982387122
Provider Name (Legal Business Name): LAURA QUINONEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 CYPRESS ST STE E
FORT BRAGG CA
95437-5458
US

IV. Provider business mailing address

347 CYPRESS ST STE E
FORT BRAGG CA
95437-5458
US

V. Phone/Fax

Practice location:
  • Phone: 707-234-8924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: