MEDICARE: CORBIN QUINN MSW, PHD

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	68421	MN

General Provider Information

NPI Number	:	1548922149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORBIN QUINN MSW, PHD

Provider Business Mailing Address
First Line	:	PO BOX 8211
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-0211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 29TH AVE SE APT F
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2742
Country	:	US
Telephone Number	:	651-271-5834
Fax Number	:

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	10/11/2021

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