Provider Demographics
NPI:1699240606
Name:RANDAZZO, RONDA MARIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:MARIE
Last Name:RANDAZZO
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 1:1 SHAKER LN
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-5156
Mailing Address - Country:US
Mailing Address - Phone:978-270-1816
Mailing Address - Fax:
Practice Address - Street 1:309 WAVERLY OAKS RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8443
Practice Address - Country:US
Practice Address - Phone:617-393-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1185031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical