Provider Demographics
NPI:1295049161
Name:QUINN, MARY J (MED,LSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:QUINN
Suffix:
Gender:F
Credentials:MED,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1287
Mailing Address - Country:US
Mailing Address - Phone:413-586-5555
Mailing Address - Fax:
Practice Address - Street 1:29 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1287
Practice Address - Country:US
Practice Address - Phone:413-586-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA302334104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker