Basic Information
| Provider Information | |||||||||
| NPI: | 1891321162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANDALL | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16308 BRIDGELAWN AVE | ||||||||
| Address2: | |||||||||
| City: | LITHIA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335474850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138338688 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6152 DELANCEY STATION ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335784206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134456122 | ||||||||
| FaxNumber: | 8134456122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2020 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW11906 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.