Provider Demographics
NPI:1871344481
Name:RISSING, RANDALL REGINALD JR (LMSW)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:REGINALD
Last Name:RISSING
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 COUNTRY SQUIRE DR UNIT G
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2528
Mailing Address - Country:US
Mailing Address - Phone:860-857-8129
Mailing Address - Fax:
Practice Address - Street 1:682 PROSPECT AVE # 103
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4238
Practice Address - Country:US
Practice Address - Phone:860-663-8131
Practice Address - Fax:888-918-2702
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker