Healthcare Provider Details

I. General information

NPI: 1770857773
Provider Name (Legal Business Name): WHITNEY ANN EDWARDS RANDALL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 BROADWAY, MAIL CODE 2606 ALFRED LERNER HALL, 8TH FLOOR
NEW YORK NY
10027-7164
US

IV. Provider business mailing address

2920 BROADWAY, MAIL CODE 2606 ALFRED LERNER HALL, 8TH FLOOR
NEW YORK NY
10027-7164
US

V. Phone/Fax

Practice location:
  • Phone: 212-854-2878
  • Fax:
Mailing address:
  • Phone: 212-854-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019505
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9453
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: