Provider Demographics
NPI:1255194650
Name:SLAUGHTER, RANDY (LMHC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3140
Mailing Address - Country:US
Mailing Address - Phone:646-765-9581
Mailing Address - Fax:
Practice Address - Street 1:921 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-3140
Practice Address - Country:US
Practice Address - Phone:646-765-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01347201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health