Provider Demographics
NPI:1578693123
Name:QUINN, AMY WARD (MA, IMF)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:WARD
Last Name:QUINN
Suffix:
Gender:F
Credentials:MA, IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22471 ASPAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1642
Mailing Address - Country:US
Mailing Address - Phone:949-458-2715
Mailing Address - Fax:949-458-3583
Practice Address - Street 1:22471 ASPAN STREET
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:949-458-2715
Practice Address - Fax:949-458-3583
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAIMF 67108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health