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General NPI Number Information
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NPI Number | 1730169202
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Entity Type | Individual
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Provider Name | QUINN STEVEN BASTIAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 2080 CHILD STREET MENTAL HEALTH DEPT - BLDG 2034 / NH JAX
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City | JACKSONVILLE
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State | FL
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Zip | 32214
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Country | US
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Telephone | 904-542-3473
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 CHILD STREET MENTAL HEALTH DEPT - BLDG 2034 / NH JAX
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City | JACKSONVILLE
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State | FL
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Zip | 32214
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Country | US
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Telephone | 904-542-3473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7448
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | PY7448
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7448
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY7448
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PY7448
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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