Provider Demographics
NPI:1265032957
Name:NEBLETT, RANDY (LCSW)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:NEBLETT
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 1:104 MAIN ST UNIT 1105
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-1743
Mailing Address - Country:US
Mailing Address - Phone:916-316-2756
Mailing Address - Fax:
Practice Address - Street 1:104 MAIN ST UNIT 1105
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-1743
Practice Address - Country:US
Practice Address - Phone:916-316-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALC171611041C0700X
MELC171611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical