Provider Demographics
NPI:1528533643
Name:SENCIBOY, RANDI NECOLE (LMSW, MAADC II)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:NECOLE
Last Name:SENCIBOY
Suffix:
Gender:F
Credentials:LMSW, MAADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:MO
Mailing Address - Zip Code:63774-0005
Mailing Address - Country:US
Mailing Address - Phone:618-806-3912
Mailing Address - Fax:
Practice Address - Street 1:619 N BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4313
Practice Address - Country:US
Practice Address - Phone:573-334-3496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180317681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical