Provider Demographics
NPI:1295984722
Name:QUILTY, ANDREA RAIMONDI (RN/PC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RAIMONDI
Last Name:QUILTY
Suffix:
Gender:F
Credentials:RN/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HARRISON AVE
Mailing Address - Street 2:DOWLING 9
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4001
Mailing Address - Country:US
Mailing Address - Phone:617-414-5245
Mailing Address - Fax:617-414-4517
Practice Address - Street 1:850 HARRISON AVE
Practice Address - Street 2:DOWLING 9
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-5245
Practice Address - Fax:617-414-4517
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273967163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health