Provider Demographics
NPI:1659722270
Name:RANDO, LICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LICIA
Middle Name:
Last Name:RANDO
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 1:23 COLBURN DR
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2925
Mailing Address - Country:US
Mailing Address - Phone:781-784-6052
Mailing Address - Fax:
Practice Address - Street 1:23 COLBURN DR
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2925
Practice Address - Country:US
Practice Address - Phone:781-784-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2217321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical