Provider Demographics
NPI:1871661397
Name:QUINLAN, PAUL MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:QUINLAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 STATE ST
Mailing Address - Street 2:BLAKE CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-3151
Mailing Address - Country:US
Mailing Address - Phone:413-205-3420
Mailing Address - Fax:413-205-3914
Practice Address - Street 1:1000 STATE ST
Practice Address - Street 2:CURTIS BLAKE CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-3151
Practice Address - Country:US
Practice Address - Phone:413-205-3420
Practice Address - Fax:413-205-3914
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01548OtherBLUE CROSS ID