Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 8566 | MA |
N | 103T00000X | Psychologist | 8566 | MA |
N | 103G00000X | Clinical Psychologist | 8566 | MA |
N | 103TC0700X | Clinical Psychologist | 8566 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 8566 | MA |
NPI | 1003977109 |
---|---|
Provider Name | Dr. David W Randall |
First Address | Lexington, MA 02421-7833 |
Second Address | Lexington, MA 02421-7833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |