=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053712893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUINLAN COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2014
-----------------------------------------------------
Last Update Date | 09/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 WASHINGTON ST SUITE LL116
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03820-4075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-351-6612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53 WASHINGTON ST SUITE LL116
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03820-4075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-351-6612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEPHEN QUINLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-351-6612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1305
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------