Healthcare Provider Details

I. General information

NPI: 1295249340
Provider Name (Legal Business Name): RANDI CAWLEY L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S SERVICE RD STE 23
ROSLYN HEIGHTS NY
11577-2131
US

IV. Provider business mailing address

220 S SERVICE RD # SITE23
ROSLYN HEIGHTS NY
11577-2129
US

V. Phone/Fax

Practice location:
  • Phone: 516-695-4152
  • Fax:
Mailing address:
  • Phone: 516-695-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085890
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: