Provider Demographics
NPI:1588765473
Name:RANDLE, CHRISTINE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:RANDLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 LEOMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-2013
Mailing Address - Country:US
Mailing Address - Phone:978-582-7103
Mailing Address - Fax:978-582-6264
Practice Address - Street 1:615 LEOMINSTER RD
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-2013
Practice Address - Country:US
Practice Address - Phone:978-582-7103
Practice Address - Fax:978-582-6264
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1112741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1035290OtherFALLON
MAMAGELLANOther411712
MA05420331OtherUBH
MAP08211OtherBCBS
11602293OtherCAQH
MA1852892Medicaid
MAP08211OtherBCBS