Provider Demographics
NPI:1871530410
Name:IMHOFF, RANDOLPH S (LMFT)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:S
Last Name:IMHOFF
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S WASHINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1534
Mailing Address - Country:US
Mailing Address - Phone:315-493-4900
Mailing Address - Fax:315-493-4909
Practice Address - Street 1:500 S WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1534
Practice Address - Country:US
Practice Address - Phone:315-493-4900
Practice Address - Fax:315-493-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist