Provider Demographics
NPI:1104074012
Name:QUINSON, MARY ANN (CSW)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:QUINSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 FIFTH AVENUE
Mailing Address - Street 2:14 C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0100
Mailing Address - Country:US
Mailing Address - Phone:212-722-0220
Mailing Address - Fax:212-831-9081
Practice Address - Street 1:125 EAST 84TH STREET
Practice Address - Street 2:1/C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0902
Practice Address - Country:US
Practice Address - Phone:212-722-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0371911041C0700X
MASW 107614-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical