Provider Demographics
NPI:1295795094
Name:MARKEY, RANDY (LCSW)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:MARKEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 BROADWAY ST STE 139
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5732
Mailing Address - Country:US
Mailing Address - Phone:210-474-6773
Mailing Address - Fax:
Practice Address - Street 1:4940 BROADWAY ST STE 139
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5732
Practice Address - Country:US
Practice Address - Phone:210-474-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1105891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23338Medicare ID - Type Unspecified