Provider Demographics
NPI:1982032215
Name:MCQUILLAN, BRENDA (LMSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MCQUILLAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14014 ROUTE 31 WEST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411
Mailing Address - Country:US
Mailing Address - Phone:585-589-2828
Mailing Address - Fax:585-589-6395
Practice Address - Street 1:14014 ROUTE 31 WEST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411
Practice Address - Country:US
Practice Address - Phone:585-589-2828
Practice Address - Fax:585-589-6395
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063426104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker