MEDICARE: DR. RANDY S DARON PSY.D.

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	103T00000X	Psychologist	PSY23305	CA

General Provider Information

NPI Number	:	1467808170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY S DARON PSY.D.

Provider Business Mailing Address
First Line	:	18 E BLITHEDALE AVE
Second Line	:	SUITE 14
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-1908
Country	:	US
Telephone Number	:	415-935-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 E BLITHEDALE AVE
Second Line	:	STE 14
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-1946
Country	:	US
Telephone Number	:	415-935-4407
Fax Number	:	415-381-2205

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

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	06/15/2022

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