Provider Demographics
NPI:1578864021
Name:RANDALL, JUSTINE ANNA (BCBA, LABA, LBA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ANNA
Last Name:RANDALL
Suffix:
Gender:F
Credentials:BCBA, LABA, LBA
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:WALDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 BILLINGS RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1924
Mailing Address - Country:US
Mailing Address - Phone:617-291-6149
Mailing Address - Fax:
Practice Address - Street 1:835 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2363
Practice Address - Country:US
Practice Address - Phone:860-413-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist