Provider Demographics
NPI:1396847752
Name:RANDALL, W. LYNNE F (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:W. LYNNE
Middle Name:F
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SIMON ST.
Mailing Address - Street 2:STE. 5
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-889-8648
Mailing Address - Fax:603-882-9666
Practice Address - Street 1:LAMORA PSYCHOLOGICAL ASSOC., 39 SIMON ST.
Practice Address - Street 2:STE. #5
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-889-8646
Practice Address - Fax:603-882-9666
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3811041C0700X
MA10169721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30421608Medicaid
NH30421608Medicaid