Provider Demographics
NPI:1770857773
Name:RANDALL, WHITNEY ANN EDWARDS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:ANN EDWARDS
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 BROADWAY, MAIL CODE 2606
Mailing Address - Street 2:ALFRED LERNER HALL, 8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7164
Mailing Address - Country:US
Mailing Address - Phone:212-854-2878
Mailing Address - Fax:
Practice Address - Street 1:2920 BROADWAY, MAIL CODE 2606
Practice Address - Street 2:ALFRED LERNER HALL, 8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7164
Practice Address - Country:US
Practice Address - Phone:212-854-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019505103TC0700X
MA9453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical