1477878247 NPI number — MR. RANDALL ALAN ARMS JR. LCSW

Table of content: MR. RANDALL ALAN ARMS JR. LCSW (NPI 1477878247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477878247 NPI number — MR. RANDALL ALAN ARMS JR. LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMS
Provider First Name:
RANDALL
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
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:
1477878247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 PELICAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32951-3735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-538-2553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 INDIAN RIVER BLVD
Provider Second Line Business Practice Location Address:
SUITE A210
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-5639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-245-0222
Provider Business Practice Location Address Fax Number:
772-231-5526
Provider Enumeration Date:
04/05/2010

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:  SW 5443 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-04-1928 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 018244000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com