Provider Demographics
NPI:1184740078
Name:QUINN, AGNES LENAHAN (PHD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:LENAHAN
Last Name:QUINN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AGGIE
Other - Middle Name:LENAHAN
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:45 FRANKLIN ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6017
Mailing Address - Country:US
Mailing Address - Phone:415-390-2608
Mailing Address - Fax:415-390-2608
Practice Address - Street 1:45 FRANKLIN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6017
Practice Address - Country:US
Practice Address - Phone:415-390-2608
Practice Address - Fax:415-390-2608
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11264OtherSFGH INTERNAL USE ONLY
11264OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER