Provider Demographics
NPI:1750100392
Name:RANDALL, MIRIAM SC (LPCA)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:SC
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:S
Other - Last Name:CHENAIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 HOMESTEAD PL
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 SYCAMORE WAY
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-6551
Practice Address - Country:US
Practice Address - Phone:203-483-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional