Provider Demographics
NPI:1700448354
Name:QUAIFE, BRIAN (AMFT/APPC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:QUAIFE
Suffix:
Gender:M
Credentials:AMFT/APPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WATERMAN BLVD STE A4
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1869
Mailing Address - Country:US
Mailing Address - Phone:860-303-2336
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR STE K
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-453-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA8641101YP2500X
CA122075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional