MEDICARE: DIANA S LEE-RANDALL LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1659673960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA S LEE-RANDALL LCSW

Provider Business Mailing Address
First Line	:	807 RIDGE RD STE 203
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2497
Country	:	US
Telephone Number	:	585-261-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 RIDGE RD STE 203
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2497
Country	:	US
Telephone Number	:	585-261-0388
Fax Number	:

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

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	02/03/2026

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