Provider Demographics
NPI:1174705925
Name:RANDALL, SANDRA KAY (PHD PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:KAY
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N RAYMOND AVE
Mailing Address - Street 2:#201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103
Mailing Address - Country:US
Mailing Address - Phone:626-577-7711
Mailing Address - Fax:626-577-7734
Practice Address - Street 1:30 N RAYMOND AVE
Practice Address - Street 2:#201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103
Practice Address - Country:US
Practice Address - Phone:626-577-7711
Practice Address - Fax:626-577-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17542103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist