Healthcare Provider Details

I. General information

NPI: 1760039408
Provider Name (Legal Business Name): MARYANNE QUINN LMFT, PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 01/23/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31625 US-101
SOLEDAD CA
93960
US

IV. Provider business mailing address

PO BOX 1477
MORGAN HILL CA
95038-1477
US

V. Phone/Fax

Practice location:
  • Phone: 408-569-0744
  • Fax:
Mailing address:
  • Phone: 408-569-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35617
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104638
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: