Provider Demographics
NPI:1982009213
Name:ESTEY, QUENTIN R JR (CRSW)
Entity Type:Individual
Prefix:MR
First Name:QUENTIN
Middle Name:R
Last Name:ESTEY
Suffix:JR
Gender:M
Credentials:CRSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2209
Mailing Address - Country:US
Mailing Address - Phone:630-924-3232
Mailing Address - Fax:604-352-1018
Practice Address - Street 1:170 EMERALD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3663
Practice Address - Country:US
Practice Address - Phone:603-352-1016
Practice Address - Fax:603-352-1018
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0027101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor