Provider Demographics
NPI:1699450627
Name:QUINN, KELLY RENEE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:RENEE
Last Name:QUINN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RENEE
Other - Last Name:GOODREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1577 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5263
Mailing Address - Country:US
Mailing Address - Phone:717-371-8226
Mailing Address - Fax:
Practice Address - Street 1:505 HISTORIC DR
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:PA
Practice Address - Zip Code:17579-1479
Practice Address - Country:US
Practice Address - Phone:717-687-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical