Provider Demographics
NPI:1013340140
Name:QUINN, MICHAEL THOMAS (BCBA SPED)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:QUINN
Suffix:
Gender:M
Credentials:BCBA SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PACELLA PARK DR
Mailing Address - Street 2:MAY INSTITUTE
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 PACELLA PARK DR.
Practice Address - Street 2:MAY INSTITUTE
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-0000
Practice Address - Country:US
Practice Address - Phone:781-437-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265Medicaid