Provider Demographics
NPI:1225181258
Name:PADOVER-KIRSON, RANDI JILL (LMSW)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:JILL
Last Name:PADOVER-KIRSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RESEARCH RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2701
Mailing Address - Country:US
Mailing Address - Phone:631-920-8500
Mailing Address - Fax:
Practice Address - Street 1:17 FLOWERFIELD
Practice Address - Street 2:SUITE 27
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1500
Practice Address - Country:US
Practice Address - Phone:631-920-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06788111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical