Provider Demographics
NPI:1174790844
Name:MCBRIDE, RANDALL (LCSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8453
Mailing Address - Country:US
Mailing Address - Phone:623-878-2037
Mailing Address - Fax:623-878-2302
Practice Address - Street 1:6833 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8453
Practice Address - Country:US
Practice Address - Phone:623-878-2037
Practice Address - Fax:623-878-2302
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-130961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical