Healthcare Provider Details

I. General information

NPI: 1275649287
Provider Name (Legal Business Name): STEPHEN J. QUINN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE VAMC (116B)
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE VAMC (116B)
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-4126
  • Fax:
Mailing address:
  • Phone: 857-364-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number7596
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7596
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: