Provider Demographics
NPI:1275738189
Name:MCQUEEN, CAROLYN FARWELL (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:FARWELL
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2331
Mailing Address - Country:US
Mailing Address - Phone:978-443-7269
Mailing Address - Fax:978-443-0001
Practice Address - Street 1:88 CONCORD RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2331
Practice Address - Country:US
Practice Address - Phone:978-443-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1045501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical