Provider Demographics
NPI:1073633558
Name:QUINN, BRIAN P (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:QUINN
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7904
Mailing Address - Country:US
Mailing Address - Phone:631-424-5042
Mailing Address - Fax:
Practice Address - Street 1:215 E MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7904
Practice Address - Country:US
Practice Address - Phone:631-424-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035714-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical