Provider Demographics
NPI:1487198503
Name:QUINN, CATHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 SECOND ST., #204
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5092
Mailing Address - Country:US
Mailing Address - Phone:310-551-1510
Mailing Address - Fax:310-459-3124
Practice Address - Street 1:1137 SECOND ST., #204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5092
Practice Address - Country:US
Practice Address - Phone:310-551-1510
Practice Address - Fax:310-459-3124
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical