Provider Demographics
NPI:1073977096
Name:QUILLE, TEGAN SORVINO (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TEGAN
Middle Name:SORVINO
Last Name:QUILLE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TEGAN
Other - Middle Name:
Other - Last Name:SORVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:51 JFK PARKWAY
Mailing Address - Street 2:1ST FLOOR WEST/REGUS
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078
Mailing Address - Country:US
Mailing Address - Phone:908-522-9439
Mailing Address - Fax:
Practice Address - Street 1:51 JFK PARKWAY
Practice Address - Street 2:1ST FLOOR WEST/REGUS
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078
Practice Address - Country:US
Practice Address - Phone:908-522-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO45156001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical