Provider Demographics
NPI:1982164026
Name:RANDOLPH, CLAUDIA LETICIA (LCSW)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:LETICIA
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 ZALTANA RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5595
Mailing Address - Country:US
Mailing Address - Phone:505-328-0687
Mailing Address - Fax:
Practice Address - Street 1:6236 ZALTANA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5595
Practice Address - Country:US
Practice Address - Phone:505-328-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-080631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical