Provider Demographics
NPI:1255471561
Name:MCQUINN, REBECCA J (BS, PE)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:MCQUINN
Suffix:
Gender:F
Credentials:BS, PE
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:MIRACLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 RADIO PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2346
Mailing Address - Country:US
Mailing Address - Phone:859-358-5369
Mailing Address - Fax:859-254-2743
Practice Address - Street 1:900 BEASLEY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4266
Practice Address - Country:US
Practice Address - Phone:859-358-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0452Medicare ID - Type UnspecifiedMEDICARE