Provider Demographics
NPI:1831548817
Name:QUANDT, ERIN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:QUANDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2127
Mailing Address - Country:US
Mailing Address - Phone:414-807-5233
Mailing Address - Fax:
Practice Address - Street 1:616 E RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2127
Practice Address - Country:US
Practice Address - Phone:414-807-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8519-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical