MEDICARE: MR. WILLIAM GEORGE RANDLE JR. MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	002207	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NO.002207	OTHER	MO	CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1023221744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM GEORGE RANDLE JR. MSW, LCSW

Provider Business Mailing Address
First Line	:	7045 CAMDEN CT
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-1914
Country	:	US
Telephone Number	:	314-531-1770
Fax Number	:	314-381-6796

Provider Business Practice Location Address
First Line	:	4411 N NEWSTEAD AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2534
Country	:	US
Telephone Number	:	314-531-1770
Fax Number	:	314-381-6796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. WILLIAM GEORGE RANDLE JR. MSW, LCSW” Practice Location

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