Provider Demographics
NPI:1518457902
Name:DEACON, RANDA (MSW)
Entity Type:Individual
Prefix:
First Name:RANDA
Middle Name:
Last Name:DEACON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 WHITE HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:RIVA
Mailing Address - State:MD
Mailing Address - Zip Code:21140-1334
Mailing Address - Country:US
Mailing Address - Phone:443-370-3290
Mailing Address - Fax:410-706-0140
Practice Address - Street 1:8003 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4612
Practice Address - Country:US
Practice Address - Phone:443-452-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker