Provider Demographics
NPI:1508225152
Name:RANDOLPH, HAVIVA EPSTEIN (PSYD)
Entity Type:Individual
Prefix:
First Name:HAVIVA
Middle Name:EPSTEIN
Last Name:RANDOLPH
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 1:7650 ELBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2204
Mailing Address - Country:US
Mailing Address - Phone:513-652-3615
Mailing Address - Fax:513-381-0014
Practice Address - Street 1:7650 ELBROOK AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2204
Practice Address - Country:US
Practice Address - Phone:513-652-3615
Practice Address - Fax:513-381-0014
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6624103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical