Provider Demographics
NPI:1588627574
Name:QUINN-CICALESE, LINDA ANN (NPP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:QUINN-CICALESE
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:QUINN-CICALESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GNP
Mailing Address - Street 1:2670 BRYANT DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3524
Mailing Address - Country:US
Mailing Address - Phone:516-826-2276
Mailing Address - Fax:
Practice Address - Street 1:2670 BRYANT DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3524
Practice Address - Country:US
Practice Address - Phone:516-826-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400416-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92V291Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER