Provider Demographics
NPI:1164042941
Name:SCHWEINBERG, RANDOLPH JAMES II
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:JAMES
Last Name:SCHWEINBERG
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 GENTILLY BLVD # 489
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-4858
Mailing Address - Country:US
Mailing Address - Phone:504-867-8916
Mailing Address - Fax:
Practice Address - Street 1:4114 OLD GENTILLY RD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-4931
Practice Address - Country:US
Practice Address - Phone:504-867-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4878101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health