Provider Demographics
NPI:1790847291
Name:QUINN, ALAN RAYMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RAYMOND
Last Name:QUINN
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 1:644 E CYPRESS ST
Mailing Address - Street 2:P.O. BOX 22
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2447
Mailing Address - Country:US
Mailing Address - Phone:610-444-9665
Mailing Address - Fax:610-444-0584
Practice Address - Street 1:644 E CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2447
Practice Address - Country:US
Practice Address - Phone:610-444-9665
Practice Address - Fax:610-444-0584
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002301 L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18952OtherBC BS
PA4343397OtherAETNA
PA18952OtherBC BS