Provider Demographics
NPI:1922412451
Name:MCQUEEN, RICARDO WELLINGTON SR (ETC)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:WELLINGTON
Last Name:MCQUEEN
Suffix:SR
Gender:M
Credentials:ETC
Other - Prefix:
Other - First Name:RICARDO
Other - Middle Name:WELLINGTON
Other - Last Name:MCQUEEN
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:ETC
Mailing Address - Street 1:1950 LEE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1859
Mailing Address - Country:US
Mailing Address - Phone:407-960-7373
Mailing Address - Fax:407-960-7375
Practice Address - Street 1:1950 LEE RD STE 204
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7210
Practice Address - Country:US
Practice Address - Phone:407-960-7373
Practice Address - Fax:407-960-7375
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator