Provider Demographics
NPI:1225818792
Name:RANDAZZO, MELANIE RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:RENEE
Last Name:RANDAZZO
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 1:954 E FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1476
Mailing Address - Country:US
Mailing Address - Phone:503-880-5965
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2259
Practice Address - Country:US
Practice Address - Phone:503-880-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0191271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical