Provider Demographics
NPI:1588181572
Name:MCQUEEN, BRIANNA (LSW)
Entity Type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:11156 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-5815
Mailing Address - Country:US
Mailing Address - Phone:513-772-6166
Mailing Address - Fax:513-772-6177
Practice Address - Street 1:11156 CANAL RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-5816
Practice Address - Country:US
Practice Address - Phone:513-772-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid