Provider Demographics
NPI:1902213564
Name:QUINBY, SCOTT LYON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LYON
Last Name:QUINBY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 740 1851 STATE ROUTE 56
Mailing Address - Street 2:MADISON CORRECTIONAL INSTITUTION
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140
Mailing Address - Country:US
Mailing Address - Phone:740-852-9777
Mailing Address - Fax:740-852-3666
Practice Address - Street 1:1851 STATE ROUTE 56
Practice Address - Street 2:MADISON CORRECTIONAL INSTITUTION
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140
Practice Address - Country:US
Practice Address - Phone:740-852-9777
Practice Address - Fax:740-852-3666
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical