Provider Demographics
NPI:1659798197
Name:MCQUINN, PENNY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:
Last Name:MCQUINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1120
Mailing Address - Country:US
Mailing Address - Phone:518-353-3035
Mailing Address - Fax:518-536-9014
Practice Address - Street 1:17 AVERY RD
Practice Address - Street 2:
Practice Address - City:BRUSHTON
Practice Address - State:NY
Practice Address - Zip Code:12916-3400
Practice Address - Country:US
Practice Address - Phone:518-353-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090214104100000X
NY0856131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05024319Medicaid