Provider Demographics
NPI:1942981162
Name:SUGAWARA, RANDALL KEI (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:KEI
Last Name:SUGAWARA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 9TH ST # B
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2104
Mailing Address - Country:US
Mailing Address - Phone:415-533-4827
Mailing Address - Fax:
Practice Address - Street 1:1335 STANFORD AVENUE
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608
Practice Address - Country:US
Practice Address - Phone:510-985-1199
Practice Address - Fax:510-985-1191
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103T00000XBehavioral Health & Social Service ProvidersPsychologist