Provider Demographics
NPI:1407846553
Name:QUINLAN, MARY P (LICSW LADC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:P
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:LICSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1218
Mailing Address - Country:US
Mailing Address - Phone:413-774-1000
Mailing Address - Fax:413-774-1197
Practice Address - Street 1:215 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-9622
Practice Address - Country:US
Practice Address - Phone:413-774-1000
Practice Address - Fax:413-774-1197
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1753101YA0400X
MA10228201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
QUP22425Medicare ID - Type Unspecified