Provider Demographics
NPI:1699492470
Name:RANDOLPH BEHAVIORAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:RANDOLPH BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:ROLLANDE
Authorized Official - Last Name:CLAUDOMIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-885-7530
Mailing Address - Street 1:PO BOX 4414
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33424-4414
Mailing Address - Country:US
Mailing Address - Phone:561-727-8635
Mailing Address - Fax:561-727-8684
Practice Address - Street 1:1500 GATEWAY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7233
Practice Address - Country:US
Practice Address - Phone:561-727-8635
Practice Address - Fax:855-284-1305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANDOLPH BEHAVIORAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-24
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty