Healthcare Provider Details

I. General information

NPI: 1306143441
Provider Name (Legal Business Name): MARGO JANEEN RANDOLPH MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MISSION AVE STE 230
OCEANSIDE CA
92058-7110
US

IV. Provider business mailing address

1701 MISSION AVE STE 230
OCEANSIDE CA
92058-7110
US

V. Phone/Fax

Practice location:
  • Phone: 760-712-3535
  • Fax: 760-439-6901
Mailing address:
  • Phone: 760-712-3535
  • Fax: 760-439-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number284557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: