Provider Demographics
NPI:1922176619
Name:RANDANT, PAULA BRAWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:BRAWN
Last Name:RANDANT
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 1:2624 TURNBULL ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5454
Mailing Address - Country:US
Mailing Address - Phone:847-922-7862
Mailing Address - Fax:
Practice Address - Street 1:119 S EMERSON ST # 203
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3219
Practice Address - Country:US
Practice Address - Phone:847-922-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW164001041C0700X
IL1490012201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01608456OtherBCBS
088324OtherMHN
088324OtherMHN