Provider Demographics
NPI:1679823736
Name:QUINN, MARTIN JOHN (LCDC III)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOHN
Last Name:QUINN
Suffix:
Gender:M
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2531
Mailing Address - Country:US
Mailing Address - Phone:216-432-0682
Mailing Address - Fax:216-731-7189
Practice Address - Street 1:3135 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2531
Practice Address - Country:US
Practice Address - Phone:216-432-0682
Practice Address - Fax:216-731-7189
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)