Provider Demographics
NPI:1265452643
Name:QUINT, MARY LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:QUINT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:KIWAK NEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL PLAZA
Mailing Address - Street 2:STE 300
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3141
Mailing Address - Country:US
Mailing Address - Phone:406-452-1171
Mailing Address - Fax:406-452-4412
Practice Address - Street 1:600 CENTRAL PLAZA
Practice Address - Street 2:STE 300
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3141
Practice Address - Country:US
Practice Address - Phone:406-452-1171
Practice Address - Fax:406-452-4412
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT538LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000502231Medicaid