Healthcare Provider Details

I. General information

NPI: 1972165256
Provider Name (Legal Business Name): AMY QUINTERO LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S EUCLID AVE
BAY CITY MI
48706-3311
US

IV. Provider business mailing address

1217 S EUCLID AVE
BAY CITY MI
48706-3311
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-9661
  • Fax: 989-667-9680
Mailing address:
  • Phone: 989-667-9661
  • Fax: 989-667-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: