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General NPI Number Information
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NPI Number | 1538538806
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Entity Type | Individual
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Provider Name | JACQUELINE G MCCUE LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 2632 HOLLYWOOD BLVD STE 304
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4857
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Country | US
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Telephone | 954-761-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 2797 1ST ST APT 1004
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City | FORT MYERS
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State | FL
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Zip | 33916-1866
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Country | US
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Telephone | 954-761-9333
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW-4739
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License Number State | FL
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