Provider Demographics
NPI:1104986272
Name:QUANTRILLE, BRETT EDWARD (LCSW)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:EDWARD
Last Name:QUANTRILLE
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 1:16614 APPOMATTOX AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3713
Mailing Address - Country:US
Mailing Address - Phone:225-755-5715
Mailing Address - Fax:225-218-4177
Practice Address - Street 1:14635 S HARRELLS FERRY RD
Practice Address - Street 2:SUITE 6 C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2959
Practice Address - Country:US
Practice Address - Phone:225-755-5715
Practice Address - Fax:225-218-4177
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical