Provider Demographics
NPI:1447629001
Name:NOLTE, RANDY (PSYD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:NOLTE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W 20TH ST STE 806
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3716
Mailing Address - Country:US
Mailing Address - Phone:212-256-1659
Mailing Address - Fax:
Practice Address - Street 1:37 W 20TH ST STE 806
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3716
Practice Address - Country:US
Practice Address - Phone:212-256-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021376103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical