Healthcare Provider Details

I. General information

NPI: 1073153458
Provider Name (Legal Business Name): QUINN MORGAN MARONEY-HERNANDEZ MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W STE 435S
SAINT PAUL MN
55114-1907
US

IV. Provider business mailing address

5544 27TH AVE S
MINNEAPOLIS MN
55417-1934
US

V. Phone/Fax

Practice location:
  • Phone: 651-647-1900
  • Fax: 651-647-1861
Mailing address:
  • Phone: 406-249-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27613
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: