Provider Demographics
NPI:1568197028
Name:QUIDACHAY, JOSITA THERESE HARRIS (LMSW, LCSW-E)
Entity Type:Individual
Prefix:
First Name:JOSITA THERESE
Middle Name:HARRIS
Last Name:QUIDACHAY
Suffix:
Gender:F
Credentials:LMSW, LCSW-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 ABG
Mailing Address - Street 2:UNIT 14021
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BONNINS BLVD
Practice Address - Street 2:BLDG 21028
Practice Address - City:YIGO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-362-4704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULMSW-E-007104100000X
GULCSW-E-0171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker