Provider Demographics
NPI:1871887315
Name:RANDALL, ROYCE DAVID
Entity type:Individual
Prefix:MR
First Name:ROYCE
Middle Name:DAVID
Last Name:RANDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4347
Mailing Address - Country:US
Mailing Address - Phone:513-316-7504
Mailing Address - Fax:
Practice Address - Street 1:1253 SEMINOLE ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4347
Practice Address - Country:US
Practice Address - Phone:513-316-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker