Provider Demographics
NPI:1063900173
Name:QUINN, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3192 DOTWOOD ST NW APT C
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4404
Mailing Address - Country:US
Mailing Address - Phone:330-734-7266
Mailing Address - Fax:
Practice Address - Street 1:1206 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1926
Practice Address - Country:US
Practice Address - Phone:330-433-2688
Practice Address - Fax:330-433-2689
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional