Provider Demographics
NPI:1710205356
Name:QUICK, ANDREA MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:QUICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3222
Mailing Address - Country:US
Mailing Address - Phone:860-938-8557
Mailing Address - Fax:860-926-0064
Practice Address - Street 1:20 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3222
Practice Address - Country:US
Practice Address - Phone:860-938-8557
Practice Address - Fax:860-926-0064
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0078231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid
CT004235918Medicaid