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General NPI Number Information
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NPI Number | 1376207035
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Entity Type | Organization
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Legal Business Name | RANDY A DEXTER
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 233 7TH ST STE 200
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City | GARDEN CITY
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State | NY
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Zip | 11530-5747
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Country | US
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Telephone | 516-210-6626
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Fax |
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Provider Business Mailing Address
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Address Line | 353 1ST ST
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City | MINEOLA
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State | NY
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Zip | 11501-3734
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Country | US
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Telephone | 516-210-6626
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | RANDY DEXTER
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Credential | LPC
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Telephone | 516-210-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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