Provider Demographics
NPI:1902074024
Name:QUINLAN, ELIZABETH (R-LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:R-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ROUTE 112
Mailing Address - Street 2:SUITE C
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1232
Mailing Address - Country:US
Mailing Address - Phone:631-714-5123
Mailing Address - Fax:631-714-5124
Practice Address - Street 1:124 ROUTE 112
Practice Address - Street 2:SUITE C
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1232
Practice Address - Country:US
Practice Address - Phone:631-714-5123
Practice Address - Fax:631-714-5124
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075160-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical