Provider Demographics
NPI:1275767972
Name:MUSCARELLA, RANDI NICHOLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:NICHOLE
Last Name:MUSCARELLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 SE STREAMLET AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-4657
Mailing Address - Country:US
Mailing Address - Phone:772-873-6603
Mailing Address - Fax:
Practice Address - Street 1:665 SE STREAMLET AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-4657
Practice Address - Country:US
Practice Address - Phone:772-873-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor