Provider Demographics
NPI:1326319567
Name:MEZZETTI-QUIRK, AMANDA MELISSA (MSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MELISSA
Last Name:MEZZETTI-QUIRK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 GRANITE AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5625
Mailing Address - Country:US
Mailing Address - Phone:617-698-0991
Mailing Address - Fax:617-698-1274
Practice Address - Street 1:464 GRANITE AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5625
Practice Address - Country:US
Practice Address - Phone:617-698-0991
Practice Address - Fax:617-698-1274
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1167681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical