Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TH0004X | Health Psychologist |
NPI | 1477229276 |
---|---|
Provider Name | Stephanie Randazzo |
First Address | San Francisco, CA 94121-2506 |
Second Address | San Francisco, CA 94121-1563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2021 |
Last Update Date | 20/08/2021 |