MEDICARE: LAURIE QUINTAL LICSW

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	1041C0700X	Clinical Social Worker	210851	MA

General Provider Information

NPI Number	:	1144399130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE QUINTAL LICSW

Provider Business Mailing Address
First Line	:	9 JOHN ROLFE DR
Second Line	:
City	:	DARTMOUTH
State	:	MA
Zip	:	02747-3846
Country	:	US
Telephone Number	:	508-999-7753
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 PLYMPTON ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1602
Country	:	US
Telephone Number	:	508-947-1901
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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