Provider Demographics
NPI:1902854235
Name:RANDOS, ELENI (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ELENI
Middle Name:
Last Name:RANDOS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BLAKEY RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9493
Mailing Address - Country:US
Mailing Address - Phone:802-578-2563
Mailing Address - Fax:
Practice Address - Street 1:107 FISHER POND RD
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-6286
Practice Address - Country:US
Practice Address - Phone:802-524-6555
Practice Address - Fax:802-524-6562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2232418OtherCIGNA
VT370054OtherMHN
VT563834OtherVALUE OPTIONS
VT1009357Medicaid
VT48071OtherBCBS