=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104436880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE QUINTERO LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2020
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 SE 6TH AVE # 200
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-536-3551
-----------------------------------------------------
Fax | 561-516-7219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1210 OLD BOYNTON RD APT 101
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-3419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-398-7277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW22864
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------