Basic Information
| Provider Information | |||||||||
| NPI: | 1568602613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINTAL | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | ALEXANDRINA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PSYCH NP, PSYCH CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 CITY HALL MALL | ||||||||
| Address2: | 3RD FLOOR BEHAVIORAL HEALTH | ||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021554754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813065100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26 CITY HALL MALL | ||||||||
| Address2: | 3RD FLOOR BEHAVIORAL HEALTH | ||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021554754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813065100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2009 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | RN205657 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 364SP0809X | RN205657 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.