Provider Demographics
NPI:1316396575
Name:QUIRK, BRADLEY (LMSW)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:QUIRK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CONGAMOND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9404
Mailing Address - Country:US
Mailing Address - Phone:860-471-2841
Mailing Address - Fax:
Practice Address - Street 1:1251 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5050
Practice Address - Country:US
Practice Address - Phone:860-346-0771
Practice Address - Fax:860-346-0772
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2743104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker