Healthcare Provider Details

I. General information

NPI: 1285814327
Provider Name (Legal Business Name): MONICA J QUINN MA CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36250 DEQUINDRE RD SUITE 310
STERLING HEIGHTS MI
48310-7143
US

IV. Provider business mailing address

2139 ROSLYN RD
GROSSE POINTE WOODS MI
48236-1051
US

V. Phone/Fax

Practice location:
  • Phone: 586-795-0569
  • Fax:
Mailing address:
  • Phone: 313-598-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801021472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: