Provider Demographics
NPI:1528183142
Name:CHANG, RANDY K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:K
Last Name:CHANG
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 1:737 W LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1009
Mailing Address - Country:US
Mailing Address - Phone:410-706-1196
Mailing Address - Fax:410-706-8163
Practice Address - Street 1:520 W LOMBARD ST
Practice Address - Street 2:GRAY HALL, 1ST FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1603
Practice Address - Country:US
Practice Address - Phone:410-706-4869
Practice Address - Fax:410-706-3017
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01469103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical