Provider Demographics
NPI:1275975518
Name:RANDALL, TODD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:RANDALL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 210
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2509
Practice Address - Country:US
Practice Address - Phone:571-309-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical