Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | NY |
NPI | 1083256580 |
---|---|
Provider Name | Mr. Quinn Edward Funn II |
First Address | Calverton, NY 11933-9706 |
Second Address | Bay Shore, NY 11706-8305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2019 |
Last Update Date | 16/10/2019 |