Healthcare Provider Details

I. General information

NPI: 1043048739
Provider Name (Legal Business Name): BRIGID MARY RANDA MFT, PH.D CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 FUTENMA
GINOWAN OKINAWA
96362
JP

IV. Provider business mailing address

PSC 482 BOX 2478
FPO AP
96362-0025
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone: 804-185-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: