Provider Demographics
NPI:1629812359
Name:CHRISTIE, RANDI (LMSW)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 JOHN F KENNEDY BLVD APT 406
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1670
Mailing Address - Country:US
Mailing Address - Phone:646-410-3147
Mailing Address - Fax:
Practice Address - Street 1:2159 JOHN F KENNEDY BLVD APT 406
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1670
Practice Address - Country:US
Practice Address - Phone:646-410-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ016924281041S0200X
NY118935104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool