Provider Demographics
NPI:1942302674
Name:KAMEN-GREDINGER, RANDY ELLEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ELLEN
Last Name:KAMEN-GREDINGER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WHITE PINE KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3708
Mailing Address - Country:US
Mailing Address - Phone:508-358-4323
Mailing Address - Fax:508-302-8022
Practice Address - Street 1:3 WHITE PINE KNOLL RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3708
Practice Address - Country:US
Practice Address - Phone:508-358-4323
Practice Address - Fax:508-302-8022
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3260103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy