Provider Demographics
NPI:1043721244
Name:MACHADO, RANDY (LMHC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:MACHADO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HAYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2123
Mailing Address - Country:US
Mailing Address - Phone:401-624-6942
Mailing Address - Fax:
Practice Address - Street 1:224 HAYDEN AVE
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-2123
Practice Address - Country:US
Practice Address - Phone:401-624-6942
Practice Address - Fax:401-624-6942
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health