Provider Demographics
NPI:1275733909
Name:SEMPLE, RANDYE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDYE
Middle Name:J
Last Name:SEMPLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SAN PABLO ST
Mailing Address - Street 2:STE 1652
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5321
Mailing Address - Country:US
Mailing Address - Phone:323-442-6000
Mailing Address - Fax:323-442-6001
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:STE 1652
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5321
Practice Address - Country:US
Practice Address - Phone:323-442-6000
Practice Address - Fax:323-442-6001
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016941103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TP2701X
CAPSY22072103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016941OtherLICENSED PSYCHOLOGIST
CAPSY22072OtherLICENSED PSYCHOLOGIST