Provider Demographics
NPI:1437224342
Name:QUINLAN, STEPHEN M (LICSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:QUINLAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WASHINGTON ST
Mailing Address - Street 2:SUITE LL116
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4075
Mailing Address - Country:US
Mailing Address - Phone:207-351-6612
Mailing Address - Fax:
Practice Address - Street 1:53 WASHINGTON ST
Practice Address - Street 2:SUITE LL116
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4075
Practice Address - Country:US
Practice Address - Phone:207-351-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NHNH3227Medicare ID - Type Unspecified