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NPI Code Detail

MEDICARE: MARY MARGARET MCQUEEN BCBA

MEDICARE: MARY MARGARET MCQUEEN BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1104544980
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY MARGARET MCQUEEN BCBA
Provider Business Mailing Address
First Line : 65 PROFESSIONAL PL STE 102103
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-0258
Country : US
Telephone Number : 304-848-5770
Fax Number : 304-848-0890
Provider Business Practice Location Address
First Line : 65 PROFESSIONAL PL STE 102103
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-0258
Country : US
Telephone Number : 304-848-5770
Fax Number : 304-848-0890
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2022
Last Update Date : 04/08/2026

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Directions to “ MARY MARGARET MCQUEEN BCBA” Practice Location

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