Healthcare Provider Details

I. General information

NPI: 1427989581
Provider Name (Legal Business Name): JEAN MARIE QUINTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CAPTAIN THOMAS BLVD APT 203
WEST HAVEN CT
06516-8923
US

IV. Provider business mailing address

256 CAPTAIN THOMAS BLVD APT 203
WEST HAVEN CT
06516-8923
US

V. Phone/Fax

Practice location:
  • Phone: 646-256-0158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: