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General NPI Number Information
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NPI Number | 1770984148
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Entity Type | Individual
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Provider Name | JENNIFER MARIE QUAGLIARIELLO LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 101 ORCHARD PARK DR
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City | GREENVILLE
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State | SC
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Zip | 29615-3531
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Country | US
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Telephone | 864-729-6606
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Fax | 855-617-4426
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Provider Business Mailing Address
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Address Line | 6416 OLD WINTER GARDEN RD
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City | ORLANDO
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State | FL
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Zip | 32835-1348
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Country | US
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Telephone | 407-751-7288
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Fax | 407-770-0661
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C011784
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 56209
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12719
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License Number State | SC
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