Provider Demographics
NPI:1902158173
Name:ALMERICO-LECLAIR, QUINN A (LICSW)
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:A
Last Name:ALMERICO-LECLAIR
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 1:25 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3603
Mailing Address - Country:US
Mailing Address - Phone:718-683-0932
Mailing Address - Fax:
Practice Address - Street 1:73 HIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3026
Practice Address - Country:US
Practice Address - Phone:718-683-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079222-11041C0700X
MA1189721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331943Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY00695941Medicaid
NY331043Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331978Medicare Oscar/Certification