Provider Demographics
NPI:1831682392
Name:QUINN, STEPHANIE KIERSTEAD (LICSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KIERSTEAD
Last Name:QUINN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1141
Mailing Address - Country:US
Mailing Address - Phone:207-939-8250
Mailing Address - Fax:
Practice Address - Street 1:190 OLD DERBY ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4006
Practice Address - Country:US
Practice Address - Phone:207-939-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1158171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical