Provider Demographics
NPI:1265923197
Name:QUINN, DANIEL JAMES (LICSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:QUINN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:JAMES
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:P.O. BOX 762
Mailing Address - Street 2:
Mailing Address - City:HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06438
Mailing Address - Country:US
Mailing Address - Phone:475-254-2298
Mailing Address - Fax:
Practice Address - Street 1:30 OLD KINGS HWY S
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4551
Practice Address - Country:US
Practice Address - Phone:475-254-2298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH29451041C0700X
MA10175381041C0700X
CT128881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty