Provider Demographics
NPI:1386115046
Name:RANDELL, ANDREA CHARIDEMOU (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHARIDEMOU
Last Name:RANDELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 31ST ST # 1141
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1140
Mailing Address - Country:US
Mailing Address - Phone:646-902-4144
Mailing Address - Fax:
Practice Address - Street 1:2441 31ST ST # 1141
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1140
Practice Address - Country:US
Practice Address - Phone:646-902-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY0955391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker