Healthcare Provider Details

I. General information

NPI: 1568897544
Provider Name (Legal Business Name): ANDREA LYNN RAND LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BULLOCKS POINT AVE
RIVERSIDE RI
02915-5351
US

IV. Provider business mailing address

100 BULLOCKS POINT AVE
RIVERSIDE RI
02915-5351
US

V. Phone/Fax

Practice location:
  • Phone: 401-437-1008
  • Fax:
Mailing address:
  • Phone: 401-437-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118895
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW03863
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: