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General NPI Number Information
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NPI Number | 1902154750
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Entity Type | Individual
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Provider Name | LESLIE J. QUINN PHD, LCSW, CGP
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Gender | Female
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 168 W 86TH ST SUITE 1D
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City | NEW YORK
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State | NY
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Zip | 10024
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Country | US
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Telephone | 212-865-7315
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Fax |
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Provider Business Mailing Address
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Address Line | 168 W 86TH ST APT 1D
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City | NEW YORK
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State | NY
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Zip | 10024-4023
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Country | US
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Telephone | 212-865-7315
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 000137-1
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License Number State | NY
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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 | R039008-1
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License Number State | NY
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