Provider Demographics
NPI:1669195566
Name:QUINN, MICHAEL E (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:QUINN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N BERETANIA ST APT 605
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4755
Mailing Address - Country:US
Mailing Address - Phone:407-575-2720
Mailing Address - Fax:
Practice Address - Street 1:60 N BERETANIA ST APT 605
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4755
Practice Address - Country:US
Practice Address - Phone:407-575-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-4846101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health