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NPI Code Detail

MEDICARE: NICOLE RANDOLPH

MEDICARE: NICOLE RANDOLPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1174470363
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE RANDOLPH
Provider Business Mailing Address
First Line : 1777 REISTERSTOWN RD STE 165R
Second Line :
City : PIKESVILLE
State : MD
Zip : 21208-1387
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1517 REISTERSTOWN RD
Second Line :
City : PIKESVILLE
State : MD
Zip : 21208-4325
Country : US
Telephone Number : 410-541-1316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ NICOLE RANDOLPH ” Practice Location

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