Provider Demographics
NPI:1770150559
Name:QUINN, CHANNYN (MHC-BS)
Entity type:Individual
Prefix:
First Name:CHANNYN
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:MHC-BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DEERHURST LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2762
Mailing Address - Country:US
Mailing Address - Phone:585-545-9362
Mailing Address - Fax:
Practice Address - Street 1:490 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1297
Practice Address - Country:US
Practice Address - Phone:585-922-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health