Provider Demographics
NPI:1407033640
Name:DYMOND, RANDY ALLEN (MS, MPA)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:ALLEN
Last Name:DYMOND
Suffix:
Gender:M
Credentials:MS, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:CENTRAL NEW YORK PSYCHIATRIC CENTER, OLD RIVER ROAD
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403
Mailing Address - Country:US
Mailing Address - Phone:315-765-3647
Mailing Address - Fax:315-765-3659
Practice Address - Street 1:CENTRAL NEW YORK PSYCHIATRIC CENTER, OLD RIVER ROAD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403
Practice Address - Country:US
Practice Address - Phone:315-765-3647
Practice Address - Fax:315-765-3659
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-27930-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical