Provider Demographics
NPI:1255504577
Name:KASPER, RANDY ELLEN
Entity Type:Individual
Prefix:MS
First Name:RANDY
Middle Name:ELLEN
Last Name:KASPER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RANDY
Other - Middle Name:ELLEN
Other - Last Name:KASPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:595 E COLORADO BLVD STE 431
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2057
Mailing Address - Country:US
Mailing Address - Phone:213-434-0700
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 431
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2057
Practice Address - Country:US
Practice Address - Phone:213-434-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS169741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical