Provider Demographics
NPI:1760173090
Name:QUINN, NATHAN (LPCA, RMHCI)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:LPCA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3415
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:
Practice Address - Street 1:197 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3415
Practice Address - Country:US
Practice Address - Phone:352-448-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23089101YM0800X
CT7025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health