Healthcare Provider Details

I. General information

NPI: 1811807134
Provider Name (Legal Business Name): FRIDA FLORES RANDOLFI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1710 36TH ST BLDG A
VERO BEACH FL
32960-4824
US

IV. Provider business mailing address

335 53RD CIR
VERO BEACH FL
32968-2241
US

V. Phone/Fax

Practice location:
  • Phone: 772-205-6643
  • Fax:
Mailing address:
  • Phone: 239-692-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: