Provider Demographics
NPI:1487733267
Name:QUINN, DAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4658 SAN SEBASTIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1443
Mailing Address - Country:US
Mailing Address - Phone:510-290-8297
Mailing Address - Fax:
Practice Address - Street 1:1425 LEIMERT BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1865
Practice Address - Country:US
Practice Address - Phone:510-290-8297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23350103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist