Provider Demographics
NPI:1427375559
Name:RADD, RANDY ROBERT (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:ROBERT
Last Name:RADD
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4499 ROUTE 27
Mailing Address - Street 2:2ND FLOOR, SUITE 1
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528-9600
Mailing Address - Country:US
Mailing Address - Phone:732-735-3558
Mailing Address - Fax:732-823-6050
Practice Address - Street 1:4499 ROUTE 27
Practice Address - Street 2:2ND FLOOR, SUITE 1
Practice Address - City:KINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:08528-9600
Practice Address - Country:US
Practice Address - Phone:732-735-3558
Practice Address - Fax:732-823-6050
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053105001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical