Provider Demographics
NPI:1528186186
Name:QUAST, LAUREL MARLINK (LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:MARLINK
Last Name:QUAST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 MONTICELLO CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8603
Mailing Address - Country:US
Mailing Address - Phone:707-571-1714
Mailing Address - Fax:707-573-7099
Practice Address - Street 1:70 ST JAMES DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1420
Practice Address - Country:US
Practice Address - Phone:707-571-1714
Practice Address - Fax:707-573-7099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA203141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical