Provider Demographics
NPI:1023120318
Name:RAMIREZ, RANDALL ANTHONY (LCSW MFT)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:ANTHONY
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:LCSW MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16275 MONTEREY RD
Mailing Address - Street 2:STE. C
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5466
Mailing Address - Country:US
Mailing Address - Phone:408-778-5120
Mailing Address - Fax:408-778-9917
Practice Address - Street 1:16275 MONTEREY RD
Practice Address - Street 2:SUITE C
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5466
Practice Address - Country:US
Practice Address - Phone:408-778-5120
Practice Address - Fax:408-778-9917
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS92061041C0700X
CAMFC17052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP#079075OtherCA CHILDRENS SERVICES