Provider Demographics
NPI:1235116526
Name:KROGSTAD, RANDI ADELE (MSW)
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:ADELE
Last Name:KROGSTAD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 COLBURN RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-3407
Mailing Address - Country:US
Mailing Address - Phone:860-684-7215
Mailing Address - Fax:
Practice Address - Street 1:128 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1556
Practice Address - Country:US
Practice Address - Phone:508-418-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health