MEDICARE: ALEXA RANDALL

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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1275133381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA RANDALL

Provider Business Mailing Address
First Line	:	270 PICKEREL POINT RD
Second Line	:
City	:	SANBORNVILLE
State	:	NH
Zip	:	03872-3769
Country	:	US
Telephone Number	:	518-307-9022
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 ROCHESTER HILL RD STE 2
Second Line	:
City	:	ROCHESTER
State	:	NH
Zip	:	03867-1709
Country	:	US
Telephone Number	:	603-994-6487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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Directions to “ ALEXA RANDALL ” Practice Location

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