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General NPI Number Information
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NPI Number | 1477793974
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Entity Type | Individual
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Provider Name | CHRIS F. RANDOLPH LCAT
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Gender | Female
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 137 FIRST AVENUE
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City | NYACK
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State | NY
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Zip | 10960
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Country | US
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Telephone | 845-893-6674
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Fax |
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Provider Business Mailing Address
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Address Line | 1581 ROUTE 202 #327
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City | POMONA
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State | NY
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Zip | 10970
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Country | US
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Telephone | 845-893-6674
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Fax | 801-340-5401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 001187
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License Number State | NY
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