Healthcare Provider Details

I. General information

NPI: 1003977109
Provider Name (Legal Business Name): DAVID W RANDALL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WOODCLIFFE RD
LEXINGTON MA
02421-7833
US

IV. Provider business mailing address

41 WOODCLIFFE RD
LEXINGTON MA
02421-7833
US

V. Phone/Fax

Practice location:
  • Phone: 781-538-5020
  • Fax:
Mailing address:
  • Phone: 781-538-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8566
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8566
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8566
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: