Provider Demographics
NPI:1629376140
Name:QUARESMA, AMY KATHERINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:KATHERINE
Last Name:QUARESMA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 VAN GIESEN ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2746
Mailing Address - Country:US
Mailing Address - Phone:509-946-4645
Mailing Address - Fax:509-946-1398
Practice Address - Street 1:2139 VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2746
Practice Address - Country:US
Practice Address - Phone:509-946-4645
Practice Address - Fax:509-946-1398
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALH60450483101YM0800X
WALW612995991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2043567Medicaid