Provider Demographics
NPI:1477229276
Name:RANDAZZO, STEPHANIE (PSYD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
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:PO BOX 22212
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-0212
Mailing Address - Country:US
Mailing Address - Phone:718-873-3286
Mailing Address - Fax:
Practice Address - Street 1:166 GEARY STR 1
Practice Address - Street 2:5TH FL #1042
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:510-761-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34020103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist