Provider Demographics
NPI:1821396524
Name:QUINONES, ISIDRA LUZ
Entity Type:Individual
Prefix:
First Name:ISIDRA
Middle Name:LUZ
Last Name:QUINONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MERCIER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4746
Mailing Address - Country:US
Mailing Address - Phone:857-221-2815
Mailing Address - Fax:
Practice Address - Street 1:40 MERCIER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-4746
Practice Address - Country:US
Practice Address - Phone:857-221-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health