Provider Demographics
NPI:1316557846
Name:ANDREA QUICK COUNSELING & MEDIATION LLC
Entity Type:Organization
Organization Name:ANDREA QUICK COUNSELING & MEDIATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-938-8556
Mailing Address - Street 1:20 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3222
Mailing Address - Country:US
Mailing Address - Phone:860-938-8557
Mailing Address - Fax:
Practice Address - Street 1:20 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3222
Practice Address - Country:US
Practice Address - Phone:860-938-8557
Practice Address - Fax:860-926-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004243747Medicaid