Provider Demographics
NPI:1174414684
Name:REID, RANDY
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:REID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE
Mailing Address - State:PA
Mailing Address - Zip Code:16843-4333
Mailing Address - Country:US
Mailing Address - Phone:682-478-5124
Mailing Address - Fax:
Practice Address - Street 1:1801 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:HYDE
Practice Address - State:PA
Practice Address - Zip Code:16843-4333
Practice Address - Country:US
Practice Address - Phone:682-478-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor