MEDICARE: TARA QUINLAN LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL05827200	NJ

General Provider Information

NPI Number	:	1033775275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA QUINLAN LSW

Provider Business Mailing Address
First Line	:	2701 RENAISSANCE BLVD FL 4
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-2781
Country	:	US
Telephone Number	:	484-803-9663
Fax Number	:	484-393-4096

Provider Business Practice Location Address
First Line	:	526 S BURNT MILL RD
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-2205
Country	:	US
Telephone Number	:	856-559-2190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	05/14/2019

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