Provider Demographics
NPI:1891321162
Name:RANDALL, CATHERINE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16308 BRIDGELAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4850
Mailing Address - Country:US
Mailing Address - Phone:813-833-8688
Mailing Address - Fax:
Practice Address - Street 1:6152 DELANCEY STATION ST STE 206
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4206
Practice Address - Country:US
Practice Address - Phone:813-445-6122
Practice Address - Fax:813-445-6122
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW119061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical