Provider Demographics
NPI:1265626527
Name:BROWN-MCQUEEN, MELISSA A (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BROWN-MCQUEEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 E EDGEWOOD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3660
Mailing Address - Country:US
Mailing Address - Phone:863-797-6183
Mailing Address - Fax:
Practice Address - Street 1:2033 E EDGEWOOD DR
Practice Address - Street 2:SUITE 4
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3660
Practice Address - Country:US
Practice Address - Phone:863-797-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW87191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW8719OtherSTATE OF FLORIDA