Provider Demographics
NPI:1730761479
Name:RANDALL, PHADADRIA MICHELE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PHADADRIA
Middle Name:MICHELE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 STATE ROUTE 10 # 1013
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1542
Mailing Address - Country:US
Mailing Address - Phone:201-503-7770
Mailing Address - Fax:
Practice Address - Street 1:310 ELMIRA TRL
Practice Address - Street 2:
Practice Address - City:HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07843-1110
Practice Address - Country:US
Practice Address - Phone:201-503-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062629001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical