Provider Demographics
NPI:1205436466
Name:LUNDQUIST, PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ASTOR DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2030
Mailing Address - Country:US
Mailing Address - Phone:516-432-5410
Mailing Address - Fax:
Practice Address - Street 1:751 COATES AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-6039
Practice Address - Country:US
Practice Address - Phone:631-306-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0820351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty