Provider Demographics
NPI:1134511272
Name:QUISENBERRY, LINDSEY (PSYD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:QUISENBERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:KORENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:501 GOODLETTE RD N
Mailing Address - Street 2:STE A202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-4894
Mailing Address - Country:US
Mailing Address - Phone:239-732-5959
Mailing Address - Fax:
Practice Address - Street 1:1100 S HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4207
Practice Address - Country:US
Practice Address - Phone:312-433-4925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9362103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical