Provider Demographics
NPI:1952504235
Name:RANDOLPH, CATHY M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:M
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W FOSTER ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3810
Mailing Address - Country:US
Mailing Address - Phone:781-704-8218
Mailing Address - Fax:
Practice Address - Street 1:1 W FOSTER ST
Practice Address - Street 2:SUITE 12
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3810
Practice Address - Country:US
Practice Address - Phone:781-704-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA309273-00174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist