Provider Demographics
NPI:1578108866
Name:QUINTANA, ROSA TARGELIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:TARGELIA
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9421 YELLOW WOOD COURT
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031
Mailing Address - Country:US
Mailing Address - Phone:484-553-4179
Mailing Address - Fax:
Practice Address - Street 1:9421 YELLOWWOOD CT
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1169
Practice Address - Country:US
Practice Address - Phone:484-221-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional