Healthcare Provider Details

I. General information

NPI: 1952844680
Provider Name (Legal Business Name): BRIAN QUIGLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-6175
US

IV. Provider business mailing address

41 MALL RD
BURLINGTON MA
01805-0002
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8085
  • Fax:
Mailing address:
  • Phone: 781-744-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000222318
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: