Provider Demographics
NPI:1154482974
Name:MCQUEEN, MARILYN F (ACSW LCSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:F
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:ACSW LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E MAIN STREET
Mailing Address - Street 2:PROFESSIONAL BUILDING
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250
Mailing Address - Country:US
Mailing Address - Phone:812-265-4151
Mailing Address - Fax:812-265-5028
Practice Address - Street 1:606 E MAIN STREET
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250
Practice Address - Country:US
Practice Address - Phone:812-265-4151
Practice Address - Fax:812-265-5028
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33002012A104100000X
IN34001704A1041C0700X
IN35000907A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist