Provider Demographics
NPI:1770360695
Name:RANDAZZO, NICOLETTE PAIGE (LMSW)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:PAIGE
Last Name:RANDAZZO
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 1:1612 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2040
Mailing Address - Country:US
Mailing Address - Phone:631-766-2137
Mailing Address - Fax:
Practice Address - Street 1:1500 E BRANCH RD # 200
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6921
Practice Address - Country:US
Practice Address - Phone:814-380-9180
Practice Address - Fax:814-406-4244
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140529104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker