Provider Demographics
NPI:1568794642
Name:RANDALL, JOHN C (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:RANDALL
Suffix:
Gender:M
Credentials:MED, BCBA
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 921
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-0921
Mailing Address - Country:US
Mailing Address - Phone:508-801-2892
Mailing Address - Fax:
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1370
Practice Address - Country:US
Practice Address - Phone:508-801-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst