Provider Demographics
NPI:1467696823
Name:RANDAZZO, AMANPREET (PSYD)
Entity Type:Individual
Prefix:
First Name:AMANPREET
Middle Name:
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4911
Mailing Address - Country:US
Mailing Address - Phone:908-720-3118
Mailing Address - Fax:
Practice Address - Street 1:1009 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4911
Practice Address - Country:US
Practice Address - Phone:908-720-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08602103TC0700X
TX34091103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical