Provider Demographics
NPI:1285778894
Name:QUINN, BRENDA RENEE (LICSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:RENEE
Last Name:QUINN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 MAPLE ST
Mailing Address - Street 2:SUITE 2, BOX 6
Mailing Address - City:HOPKINTON
Mailing Address - State:NH
Mailing Address - Zip Code:03229-3377
Mailing Address - Country:US
Mailing Address - Phone:603-731-6973
Mailing Address - Fax:866-731-0420
Practice Address - Street 1:633 MAPLE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOPKINTON
Practice Address - State:NH
Practice Address - Zip Code:03229-3377
Practice Address - Country:US
Practice Address - Phone:603-731-6973
Practice Address - Fax:866-731-0420
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH843OtherLICSW