Provider Demographics
NPI:1396958401
Name:MCQUEENEY, GWENDOLYN E (LMSW)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:E
Last Name:MCQUEENEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7928
Mailing Address - Country:US
Mailing Address - Phone:917-330-6879
Mailing Address - Fax:
Practice Address - Street 1:4041 MOUNTVILLE RD.
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:MD
Practice Address - Zip Code:21755
Practice Address - Country:US
Practice Address - Phone:917-330-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074513-1104100000X
MD25495104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker