Provider Demographics
NPI:1770023970
Name:RANDAZZO, TARAH (LPC)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N MAYFAIR RD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1309
Mailing Address - Country:US
Mailing Address - Phone:414-771-9304
Mailing Address - Fax:414-771-9543
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE 650
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-771-9304
Practice Address - Fax:414-771-9543
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional