Provider Demographics
NPI:1497811574
Name:QUINN, WENDY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3787
Mailing Address - Country:US
Mailing Address - Phone:603-969-5681
Mailing Address - Fax:603-659-5239
Practice Address - Street 1:118 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3787
Practice Address - Country:US
Practice Address - Phone:603-969-5681
Practice Address - Fax:603-659-5239
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH144101YA0400X
NH1035103TC0700X
MA8111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422798Medicaid
NH30422798Medicaid