Provider Demographics
NPI:1366828626
Name:RANDAZZO, RENEE KAREN (MS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:KAREN
Last Name:RANDAZZO
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 1:17 DORAN RD # 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4115
Mailing Address - Country:US
Mailing Address - Phone:207-266-8725
Mailing Address - Fax:207-266-8725
Practice Address - Street 1:17 DORAN RD # 3
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4115
Practice Address - Country:US
Practice Address - Phone:207-266-8725
Practice Address - Fax:207-266-8725
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health