Individual provider Active NPI

Melissa A Brown-McQueen, LCSW

  • Clinical Social Worker
  • Lakeland, FL
National Provider Identifier
1265626527
Registry record updated Oct 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW8719 Issued in FL
Practice address
2033 E Edgewood Dr
Suite 4
Lakeland, FL 33803-3660
Phone
(863) 797-6183
NPI assigned
Aug 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW8719 FL Primary

Addresses

Primary practice location

2033 E Edgewood Dr
Suite 4
Lakeland, FL 33803-3660

Mailing address

2033 E Edgewood Dr
Suite 4
Lakeland, FL 33803-3660
Phone (863) 797-6183

Other identifiers 1

IdentifierTypeStateIssuer
SW8719OtherFLSTATE OF FLORIDA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100115000767 FL Practitioner - Clinical Social Worker 6800985425 Practice locations: Lakeland, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2033 E Edgewood Dr
Lakeland, FL 33803-3660
Phone (863) 797-6183

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW8719FLMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508457600000",
    "number": "1265626527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2033 E EDGEWOOD DR",
            "address_2": "SUITE 4",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338033660",
            "telephone_number": "863-797-6183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 E EDGEWOOD DR",
            "address_2": "SUITE 4",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338033660",
            "telephone_number": "863-797-6183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN-MCQUEEN",
        "first_name": "MELISSA",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2017-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW8719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA",
            "identifier": "SW8719",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.