Provider Demographics
NPI:1871011429
Name:QUINTANILHA, LUCIANA M (LICSW)
Entity Type:Individual
Prefix:
First Name:LUCIANA
Middle Name:M
Last Name:QUINTANILHA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145
Mailing Address - Country:US
Mailing Address - Phone:617-625-6600
Mailing Address - Fax:
Practice Address - Street 1:50 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2819
Practice Address - Country:US
Practice Address - Phone:617-625-6600
Practice Address - Fax:617-625-6600
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2222181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical