Provider Demographics
NPI:1740466895
Name:AUSTIN-SMALL, QUINN DAVID OLAN (PHD)
Entity type:Individual
Prefix:DR
First Name:QUINN
Middle Name:DAVID OLAN
Last Name:AUSTIN-SMALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 TROY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9499
Mailing Address - Country:US
Mailing Address - Phone:518-621-4757
Mailing Address - Fax:
Practice Address - Street 1:255 RIVER ST STE 3
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3282
Practice Address - Country:US
Practice Address - Phone:518-621-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZPYL040403103TF0200X, 103TC0700X
NY021191103TF0200X
CT4391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical