Provider Demographics
NPI:1366025645
Name:IPPOLITO, RANDI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:RANDI
Other - Middle Name:
Other - Last Name:GARTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4418 WILLIAM FLYNN HWY
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1417
Mailing Address - Country:US
Mailing Address - Phone:724-301-6764
Mailing Address - Fax:
Practice Address - Street 1:1350 OLD FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3122
Practice Address - Country:US
Practice Address - Phone:412-406-7734
Practice Address - Fax:412-406-7742
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW216601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty