Provider Demographics
NPI:1093834517
Name:QUILES, JAN K (MS)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:K
Last Name:QUILES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SUFFOLK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3642
Mailing Address - Country:US
Mailing Address - Phone:978-452-5155
Mailing Address - Fax:978-970-0713
Practice Address - Street 1:650 SUFFOLK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3642
Practice Address - Country:US
Practice Address - Phone:978-452-5155
Practice Address - Fax:978-970-0713
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor