Provider Demographics
NPI:1598881047
Name:RANDALL, SHEILA (LMSWCC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:RANDALL
Suffix:
Gender:M
Credentials:LMSWCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 RUTLAND ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4552
Mailing Address - Country:US
Mailing Address - Phone:207-947-3576
Mailing Address - Fax:
Practice Address - Street 1:1066 KENDUSKEAG AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2914
Practice Address - Country:US
Practice Address - Phone:207-941-2855
Practice Address - Fax:207-941-2835
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC6096171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications