Provider Demographics
NPI:1164610622
Name:RANDALL, STEVE C
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:C
Last Name:RANDALL
Suffix:
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 1:239 FERNWOOD BLVD.
Mailing Address - Street 2:
Mailing Address - City:FERNPARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2116
Mailing Address - Country:US
Mailing Address - Phone:407-321-4357
Mailing Address - Fax:407-324-9055
Practice Address - Street 1:239 FERNWOOD BLVD.
Practice Address - Street 2:
Practice Address - City:FERNPARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2116
Practice Address - Country:US
Practice Address - Phone:407-321-4357
Practice Address - Fax:407-324-9055
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health