Healthcare Provider Details

I. General information

NPI: 1730635186
Provider Name (Legal Business Name): ALEXANDRIA QUINONES LADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 BALLFALL RD
MIDDLETOWN CT
06457-2374
US

IV. Provider business mailing address

522 BALLFALL RD
MIDDLETOWN CT
06457-2374
US

V. Phone/Fax

Practice location:
  • Phone: 413-288-3681
  • Fax:
Mailing address:
  • Phone: 413-288-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: