1811070147 NPI number — EMILY PADGET RANDALL LICSW

Table of content: EMILY PADGET RANDALL LICSW (NPI 1811070147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811070147 NPI number — EMILY PADGET RANDALL LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANDALL
Provider First Name:
EMILY
Provider Middle Name:
PADGET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

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:
1811070147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 PORTER ST
Provider Second Line Business Mailing Address:
EAST BOSTON COUNSELING CENTER
Provider Business Mailing Address City Name:
EAST BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02128-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-429-2019
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 PORTER ST
Provider Second Line Business Practice Location Address:
EAST BOSTON COUNSELING CENTER
Provider Business Practice Location Address City Name:
EAST BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02128-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-429-2019
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

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:  1027493 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 042611055 . This is a "TAX ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18633 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1004745 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1303287 . This is a "MBHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 99618201 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 703136 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: NP01332 . This is a "BOSTON MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1303287 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P10329 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com