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General NPI Number Information
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NPI Number | 1730761479
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Entity Type | Individual
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Provider Name | PHADADRIA MICHELE RANDALL LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 310 ELMIRA TRL
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City | HOPATCONG
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State | NJ
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Zip | 07843-1110
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Country | US
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Telephone | 201-503-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 140 STATE ROUTE 10 # 1013
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City | RANDOLPH
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State | NJ
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Zip | 07869-1542
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Country | US
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Telephone | 201-503-7770
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06262900
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License Number State | NJ
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