Provider Demographics
NPI:1396328134
Name:RANDY P. NOLTE, PSY.D., PLLC
Entity type:Organization
Organization Name:RANDY P. NOLTE, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:212-256-1659
Mailing Address - Street 1:37 W 20TH ST STE 806
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3716
Mailing Address - Country:US
Mailing Address - Phone:212-256-1659
Mailing Address - Fax:
Practice Address - Street 1:37 W 20TH ST STE 806
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3716
Practice Address - Country:US
Practice Address - Phone:212-256-1659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty