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General NPI Number Information
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NPI Number | 1154482974
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Entity Type | Individual
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Provider Name | MARILYN F MCQUEEN ACSW LCSW LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 606 E MAIN STREET PROFESSIONAL BUILDING
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City | MADISON
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State | IN
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Zip | 47250
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Country | US
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Telephone | 812-265-4151
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Fax | 812-265-5028
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Provider Business Mailing Address
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Address Line | 606 E MAIN STREET PROFESSIONAL BUILDING
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City | MADISON
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State | IN
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Zip | 47250
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Country | US
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Telephone | 812-265-4151
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Fax | 812-265-5028
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33002012A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34001704A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35000907A
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License Number State | IN
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