Provider Demographics
NPI:1962916403
Name:PFAFF, RANDI MARIE
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:MARIE
Last Name:PFAFF
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 1:415 WESTERN STATES RD
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9030
Mailing Address - Country:US
Mailing Address - Phone:602-702-9040
Mailing Address - Fax:
Practice Address - Street 1:2115 7TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1663
Practice Address - Country:US
Practice Address - Phone:831-420-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health