Provider Demographics
NPI:1386068666
Name:QUIGLEY, KIM A (LSW)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:A
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2707
Mailing Address - Country:US
Mailing Address - Phone:570-342-8305
Mailing Address - Fax:570-341-9736
Practice Address - Street 1:1509 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2707
Practice Address - Country:US
Practice Address - Phone:570-342-8305
Practice Address - Fax:570-341-9736
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130049104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker