Provider Demographics
NPI:1134242043
Name:QUINN, EILEEN C (DMIN,LCSW-CLIN)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:C
Last Name:QUINN
Suffix:
Gender:F
Credentials:DMIN,LCSW-CLIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 HOFFMANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-2227
Mailing Address - Country:US
Mailing Address - Phone:410-239-7138
Mailing Address - Fax:410-239-0094
Practice Address - Street 1:4800 HOFFMANVILLE RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-2227
Practice Address - Country:US
Practice Address - Phone:410-239-7138
Practice Address - Fax:410-239-0094
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD065531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD568RMedicare ID - Type Unspecified