Provider Demographics
NPI:1083922124
Name:JANE C. QUINLAN, LCSW
Entity Type:Organization
Organization Name:JANE C. QUINLAN, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-522-8217
Mailing Address - Street 1:21 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1606
Mailing Address - Country:US
Mailing Address - Phone:207-522-8217
Mailing Address - Fax:207-319-7509
Practice Address - Street 1:21 GARDEN LN
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1606
Practice Address - Country:US
Practice Address - Phone:207-522-8217
Practice Address - Fax:207-319-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7586251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health