Healthcare Provider Details

I. General information

NPI: 1336487271
Provider Name (Legal Business Name): RANDI CAMIRAND MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 RIVER RD SUITE C
COLLINSVILLE CT
06019-3201
US

IV. Provider business mailing address

22 DEW RD
BARKHAMSTED CT
06063-3333
US

V. Phone/Fax

Practice location:
  • Phone: 860-995-0358
  • Fax:
Mailing address:
  • Phone: 860-995-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2219
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: