Provider Demographics
NPI:1447289558
Name:WORTMAN, RANDI JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:JEAN
Last Name:WORTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-661-3302
Mailing Address - Fax:301-588-8848
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-661-3302
Practice Address - Fax:301-588-8848
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist