Provider Demographics
NPI:1588226203
Name:QUINN, MOLLY (LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MCNEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 CALIFORNIA ST, PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-519-9200
Mailing Address - Fax:186-985-4635
Practice Address - Street 1:7 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-3333
Practice Address - Country:US
Practice Address - Phone:618-519-9200
Practice Address - Fax:618-684-2748
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490251841041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health