Provider Demographics
NPI:1568124006
Name:QUINONES, JUDEHIA (LMSW)
Entity Type:Individual
Prefix:
First Name:JUDEHIA
Middle Name:
Last Name:QUINONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JUDEHIA
Other - Middle Name:
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 HAIG ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3032
Mailing Address - Country:US
Mailing Address - Phone:917-648-3453
Mailing Address - Fax:
Practice Address - Street 1:605 HAIG ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3032
Practice Address - Country:US
Practice Address - Phone:917-648-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty