Healthcare Provider Details

I. General information

NPI: 1699492470
Provider Name (Legal Business Name): RANDOLPH BEHAVIORAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 LAKE WORTH RD STE 106
GREENACRES FL
33463-3213
US

IV. Provider business mailing address

PO BOX 4414
BOYNTON BEACH FL
33424-4414
US

V. Phone/Fax

Practice location:
  • Phone: 561-727-8635
  • Fax: 855-284-1305
Mailing address:
  • Phone: 561-727-8635
  • Fax: 561-727-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAPHNE ROLLANDE CLAUDOMIR
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 561-727-8635