Provider Demographics
NPI:1952315533
Name:QUINTAL, JASON S (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:S
Last Name:QUINTAL
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5460 LENA ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9500
Mailing Address - Country:US
Mailing Address - Phone:941-907-0525
Mailing Address - Fax:941-462-2968
Practice Address - Street 1:5460 LENA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9500
Practice Address - Country:US
Practice Address - Phone:941-907-0525
Practice Address - Fax:941-462-2968
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW65911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270480117OtherMANATEE CHOICE
FL270480117OtherWEBTPA
FL270480117OtherMANATEE CHOICE