Provider Demographics
NPI:1609801455
Name:FRANK, RANDY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RANDY
Middle Name:
Last Name:FRANK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4107
Mailing Address - Country:US
Mailing Address - Phone:203-335-1810
Mailing Address - Fax:203-334-0623
Practice Address - Street 1:1088 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4107
Practice Address - Country:US
Practice Address - Phone:203-335-1810
Practice Address - Fax:203-334-0623
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0033941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800001278Medicare ID - Type Unspecified