=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437235991
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDI SCHALET PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 02/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 CUMMINS HIGHWAY SUITE 2
-----------------------------------------------------
City | ROSLINDALE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-327-1942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 SOUTHAMPTON RD STE 102
-----------------------------------------------------
City | BENICIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94510-2075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-750-5721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 7268
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------