Provider Demographics
NPI:1366796518
Name:RANDELS, BRIDGET MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:RANDELS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:MARIE
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1406 CENTAUR CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1432
Mailing Address - Country:US
Mailing Address - Phone:720-837-2348
Mailing Address - Fax:303-554-5657
Practice Address - Street 1:1406 CENTAUR CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-1432
Practice Address - Country:US
Practice Address - Phone:720-837-2348
Practice Address - Fax:303-554-5657
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9357103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst