Healthcare Provider Details

I. General information

NPI: 1144641507
Provider Name (Legal Business Name): MAUREEN QUINN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 ONYX COURT
VALPARAISO IN
46385-3138
US

IV. Provider business mailing address

4203 ONYX CT
VALPARAISO IN
46385-7301
US

V. Phone/Fax

Practice location:
  • Phone: 219-246-9163
  • Fax:
Mailing address:
  • Phone: 219-246-9163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33006745A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007751A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: