Provider Demographics
NPI:1518917426
Name:QUINLAN, PAMELA WALTERS (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:WALTERS
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATTN: CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 442
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HEIDELBERG MEDDAC
Practice Address - Street 2:CMR 442
Practice Address - City:APO AE
Practice Address - State:NY
Practice Address - Zip Code:09042
Practice Address - Country:US
Practice Address - Phone:496-221-1722
Practice Address - Fax:496-221-1729
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1046311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical