Provider Demographics
NPI:1467808170
Name:DARON, RANDY S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:S
Last Name:DARON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E BLITHEDALE AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1908
Mailing Address - Country:US
Mailing Address - Phone:415-935-4407
Mailing Address - Fax:
Practice Address - Street 1:18 E BLITHEDALE AVE
Practice Address - Street 2:STE 14
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1946
Practice Address - Country:US
Practice Address - Phone:415-935-4407
Practice Address - Fax:415-381-2205
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23305103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist