Provider Demographics
NPI:1912044603
Name:QUINN-O'MALLEY, EILEEN (MFT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:QUINN-O'MALLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 MISSION GORGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3411
Mailing Address - Country:US
Mailing Address - Phone:619-787-6320
Mailing Address - Fax:619-281-3714
Practice Address - Street 1:6160 MISSION GORGE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3411
Practice Address - Country:US
Practice Address - Phone:619-787-6320
Practice Address - Fax:619-281-3714
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 41188106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist