Provider Demographics
NPI:1588142616
Name:RANDAZZO, ISABELLA R
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:R
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHIELD ST STE C
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1920
Mailing Address - Country:US
Mailing Address - Phone:860-313-1119
Mailing Address - Fax:
Practice Address - Street 1:100 SHIELD ST STE C
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1920
Practice Address - Country:US
Practice Address - Phone:860-313-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT118681041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical