MEDICARE: DR. RANDY ELLEN KAMEN-GREDINGER ED.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	3260	MA
2	103TP2701X	Group Psychotherapy Psychologist	3260	MA

General Provider Information

NPI Number	:	1942302674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY ELLEN KAMEN-GREDINGER ED.D.

Provider Business Mailing Address
First Line	:	3 WHITE PINE KNOLL RD
Second Line	:
City	:	WAYLAND
State	:	MA
Zip	:	01778-3708
Country	:	US
Telephone Number	:	508-358-4323
Fax Number	:	508-302-8022

Provider Business Practice Location Address
First Line	:	3 WHITE PINE KNOLL RD
Second Line	:
City	:	WAYLAND
State	:	MA
Zip	:	01778-3708
Country	:	US
Telephone Number	:	508-358-4323
Fax Number	:	508-302-8022

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	09/11/2025

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