Provider Demographics
NPI:1013090356
Name:QUINTILIANI, LAWRENCE JOHN
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JOHN
Last Name:QUINTILIANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LISA DR.
Mailing Address - Street 2:P.O. BOX 814
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-0814
Mailing Address - Country:US
Mailing Address - Phone:845-691-6502
Mailing Address - Fax:845-691-6502
Practice Address - Street 1:9 LISA DR.
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-0814
Practice Address - Country:US
Practice Address - Phone:845-691-6502
Practice Address - Fax:845-691-6502
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR018471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN15051Medicare ID - Type Unspecified