Provider Demographics
NPI:1619344587
Name:RANDO, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:RANDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 FENN ST
Mailing Address - Street 2:ADMINISTRATIVE OFFICES
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5261
Mailing Address - Country:US
Mailing Address - Phone:413-629-1262
Mailing Address - Fax:413-448-2198
Practice Address - Street 1:34 DEPOT ST STE 207
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5130
Practice Address - Country:US
Practice Address - Phone:413-679-0333
Practice Address - Fax:413-216-2152
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA2255631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor