Active NPI
Kathleen T Randall, LMHC, EMDR
- Professional Counselor
- Northborough, MA
National Provider Identifier
1003996505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 367
- Practice address
- 300 W Main St
Northborough, MA 01532-2132 - Phone
- (508) 351-6511
- NPI assigned
- Oct 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 367 | MA | Primary |
Addresses
Primary practice location
300 W Main St
Northborough, MA 01532-2132
Mailing address
PO Box 439
Northborough, MA 01532-0439
Phone (508) 351-6511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LM0896 | Other | MA | BLUE CROSS/BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 367 | MA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003996505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 439",
"city": "NORTHBOROUGH",
"state": "MA",
"postal_code": "015320439",
"telephone_number": "508-351-6511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W MAIN ST",
"city": "NORTHBOROUGH",
"state": "MA",
"postal_code": "015322132",
"telephone_number": "508-351-6511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "KATHLEEN",
"middle_name": "T",
"credential": "LMHC, EMDR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MA",
"license": "367",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "LM0896",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.