MEDICARE: MRS. JACQUELINE G MCCUE 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	SW-4739	FL

General Provider Information

NPI Number	:	1538538806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE G MCCUE LCSW

Provider Business Mailing Address
First Line	:	2797 1ST ST APT 1004
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-1866
Country	:	US
Telephone Number	:	954-761-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 HOLLYWOOD BLVD STE 304
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4857
Country	:	US
Telephone Number	:	954-761-9333
Fax Number	:

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

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	09/17/2015

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