Provider Demographics
NPI:1972715506
Name:RANDO, THERESE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:A
Last Name:RANDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COLLEGE HILL RD
Mailing Address - Street 2:BLDG. 30A
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2776
Mailing Address - Country:US
Mailing Address - Phone:401-823-5410
Mailing Address - Fax:401-823-1805
Practice Address - Street 1:33 COLLEGE HILL RD
Practice Address - Street 2:BLDG. 30A
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2776
Practice Address - Country:US
Practice Address - Phone:401-823-5410
Practice Address - Fax:401-823-1805
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00218103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical