Basic Information
| Provider Information | |||||||||
| NPI: | 1922657014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINTUNA | ||||||||
| FirstName: | GOVANNY | ||||||||
| MiddleName: | FERNANDO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 STANHOPE ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112374403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3476973549 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 921 E NEW YORK AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112031393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187780485 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2019 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | NY | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.