MEDICARE: MELISSA A BROWN-MCQUEEN LCSW

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
1	1041C0700X	Clinical Social Worker	SW8719	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW8719	OTHER	FL	STATE OF FLORIDA

General Provider Information

NPI Number	:	1265626527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A BROWN-MCQUEEN LCSW

Provider Business Mailing Address
First Line	:	2033 E EDGEWOOD DR
Second Line	:	SUITE 4
City	:	LAKELAND
State	:	FL
Zip	:	33803-3660
Country	:	US
Telephone Number	:	863-797-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 E EDGEWOOD DR
Second Line	:	SUITE 4
City	:	LAKELAND
State	:	FL
Zip	:	33803-3660
Country	:	US
Telephone Number	:	863-797-6183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	10/20/2017

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Directions to “ MELISSA A BROWN-MCQUEEN LCSW” Practice Location

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