Provider Demographics
NPI:1811070147
Name:RANDALL, EMILY PADGET (LICSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:PADGET
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PORTER ST
Mailing Address - Street 2:EAST BOSTON COUNSELING CENTER
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2116
Mailing Address - Country:US
Mailing Address - Phone:617-429-2019
Mailing Address - Fax:
Practice Address - Street 1:14 PORTER ST
Practice Address - Street 2:EAST BOSTON COUNSELING CENTER
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2116
Practice Address - Country:US
Practice Address - Phone:617-429-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10274931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042611055OtherTAX ID
MAM18633OtherBCBS
MA1004745OtherNHP
MA1303287OtherMBHP
MA99618201OtherNETWORK HEALTH
MA703136OtherTUFTS
NP01332OtherBOSTON MED
MA1303287Medicaid
MAP10329OtherBCBS
MA1004745OtherNHP
MAP10091Medicare ID - Type Unspecified