Provider Demographics
NPI:1063564029
Name:RANDOING, SUSAN DANNENBERG (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DANNENBERG
Last Name:RANDOING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 ANGEL FIRE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3878
Mailing Address - Country:US
Mailing Address - Phone:972-672-9124
Mailing Address - Fax:
Practice Address - Street 1:400 N ALLEN DR
Practice Address - Street 2:SUITE 208
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2555
Practice Address - Country:US
Practice Address - Phone:972-727-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87267AOtherBCBS