Healthcare Provider Details

I. General information

NPI: 1003729096
Provider Name (Legal Business Name): MRS. TANYA DELORIS RANDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 FOREST ST
EAST HARTFORD CT
06118-2310
US

IV. Provider business mailing address

44 FOREST ST APT C2
EAST HARTFORD CT
06118-2310
US

V. Phone/Fax

Practice location:
  • Phone: 743-209-9133
  • Fax:
Mailing address:
  • Phone: 743-209-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9948
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: