Provider Demographics
NPI:1568276475
Name:AVILES-QUINONES, PSIAN ISIS (LCSW)
Entity type:Individual
Prefix:
First Name:PSIAN
Middle Name:ISIS
Last Name:AVILES-QUINONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MOUNT PROSPECT AVE APT 16D
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1534
Mailing Address - Country:US
Mailing Address - Phone:732-763-1887
Mailing Address - Fax:
Practice Address - Street 1:555 MOUNT PROSPECT AVE APT 16D
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1534
Practice Address - Country:US
Practice Address - Phone:732-763-1887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062893001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical