Healthcare Provider Details

I. General information

NPI: 1316679962
Provider Name (Legal Business Name): QUINONES COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 AMBOY AVE
EDISON NJ
08837-2870
US

IV. Provider business mailing address

1036 AMBOY AVE
EDISON NJ
08837-2870
US

V. Phone/Fax

Practice location:
  • Phone: 732-587-5339
  • Fax: 732-647-1113
Mailing address:
  • Phone: 732-587-5339
  • Fax: 732-647-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN CARL QUINONES
Title or Position: OWNER
Credential: EDD
Phone: 732-713-3124