Provider Demographics
NPI:1780896357
Name:SCHWARTZ, RANDI ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:ELLEN
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 GREENLEAF RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2029
Mailing Address - Country:US
Mailing Address - Phone:410-433-6863
Mailing Address - Fax:
Practice Address - Street 1:6525 N CHARLES ST
Practice Address - Street 2:GIBSON BUILDING, SUITE 224
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6872
Practice Address - Country:US
Practice Address - Phone:410-938-8457
Practice Address - Fax:410-825-7105
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist