Healthcare Provider Details

I. General information

NPI: 1003983628
Provider Name (Legal Business Name): THOMAS P QUINN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

IV. Provider business mailing address

230 NORTH RD
POUGHKEEPSIE NY
12601-1328
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2703
  • Fax: 845-471-3406
Mailing address:
  • Phone: 845-486-2703
  • Fax: 845-471-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR042300-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: