MEDICARE: PRESTON J QUEENAN 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	SW17724	FL

General Provider Information

NPI Number	:	1336643956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRESTON J QUEENAN LCSW

Provider Business Mailing Address
First Line	:	150 TIMBERLAND TRL
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-3526
Country	:	US
Telephone Number	:	484-868-4948
Fax Number	:	844-844-1865

Provider Business Practice Location Address
First Line	:	6909 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6829
Country	:	US
Telephone Number	:	484-868-4948
Fax Number	:	844-844-1865

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	06/30/2025

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