1053401364 NPI number — MR. RANDALL CHRISTOPHER O'TOOLE LCSW

Table of content: MR. RANDALL CHRISTOPHER O'TOOLE LCSW (NPI 1053401364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053401364 NPI number — MR. RANDALL CHRISTOPHER O'TOOLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'TOOLE
Provider First Name:
RANDALL
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053401364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 TUNLAW RD NW APT 518
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20007-4814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-901-8681
Provider Business Mailing Address Fax Number:
703-425-9200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 FORBES PL
Provider Second Line Business Practice Location Address:
SUITE #210
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22151-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-425-9200
Provider Business Practice Location Address Fax Number:
703-425-9206
Provider Enumeration Date:
10/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904005712 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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