MEDICARE: MARGO JANEEN RANDOLPH 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	284557	CA

General Provider Information

NPI Number	:	1306143441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGO JANEEN RANDOLPH MSW, LCSW

Provider Business Mailing Address
First Line	:	1701 MISSION AVE STE 230
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-7110
Country	:	US
Telephone Number	:	760-712-3535
Fax Number	:	760-439-6901

Provider Business Practice Location Address
First Line	:	1701 MISSION AVE STE 230
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-7110
Country	:	US
Telephone Number	:	760-712-3535
Fax Number	:	760-439-6901

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

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	05/26/2023

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