Provider Demographics
NPI:1205956612
Name:QUIGLEY, SUE (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 PELHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072-9722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 MILL ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4598
Practice Address - Country:US
Practice Address - Phone:413-568-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300050OtherMBHP
MA1300881Medicaid
MA0300050OtherMBHP